Landscaping Work and Related Musculoskeletal Problems | RMHP


Mei Ching Lim,1 Khamisah Awang Lukman,1,2 Nelbon Giloi,1 Jac Fang Lim,1 Hazeqa Salleh,1 Ahmad Syukri Radzran,1 Mohammad Saffree Jeffree,1 Syed Sharizman Syed Abdul Rahim1

1Department of Public Health Medicine, Faculty of Medicine & Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, 88400, Malaysia; 2Centre for Occupational Safety & Health, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia

Correspondence: Khamisah Awang Lukman
Department of Public Health Medicine, Faculty of Medicine & Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, 88400, Sabah, Malaysia
Email [email protected]

Background: Work-related musculoskeletal disorders (WRMSDs) are considered one of the foremost reason of disability globally with significant economic impact due to loss of productivity. Landscaping work is considered a high-risk industry in the service sector. Landscape workers are susceptible to WRMSDs as they are exposed to high physical demands at work, and exert significant physical effort to complete daily repetitive tasks during long working hours. The aim of this study was to determine the prevalence of WRMSDs and to identify the ergonomic risk factors among landscape workers in a university setting.
Methods: This was a cross-sectional study conducted among landscape workers at a public university in Kota Kinabalu, Sabah. Interviews were conducted due to low literacy of the participants, using structured questionnaires which consist of personal characteristics, work descriptions, ergonomic risk factors, as well as self-reported WRMSD symptoms using NORDIC questionnaire. Ergonomic risk assessment (ERA) using rapid entire body assessment (REBA) was then conducted.
Results: Fifty-five of 60 landscape workers agreed to participate (92% response rate). The overall prevalence of WRMSDs among landscape workers was 85.5%. The highest prevalence involving the shoulder (65.5%), followed by neck (23.6%), wrist/hand (23.6%), and lower back (20.0%) regions based on their self-reported WRMSD symptoms over the past 12 months. Awkward posture was the risk factor identified through ergonomic risk assessment (ERA) conducted by ERA trained personnel. None of the working postures during assessment was noted to be appropriate. Although no significant difference was associated with self-reported WRMSDs, majority of the landscape workers (71%) were classified as medium ergonomic risk group using REBA, with the remaining 29% considered to be high ergonomic risk group.
Conclusion: Improvement in awareness campaigns, modification of working tools, and enhanced administrative approaches are among the control and prevention measures recommended to delay or prevent the occurrence of WRMSDs.

Keywords: awkward posture, landscape workers, work-related musculoskeletal disorders, rapid entire body assessment, REBA


According to the recent report of Global Burden of Disease (GBD) 2019, an estimated 1.71 billion people were affected by musculoskeletal illnesses worldwide with the highest prevalence in the lower back region.1 According to the Labour Force Survey (LFS), although there seems to be a downward trend of self-reported work-related musculoskeletal disorders (WRMSDs), there were approximately 480,000 WRMSDs cases with prevalence rate of 1420 per 100, 000 workers in 2019/2020.2

Work-related musculoskeletal disorders (WRMSDs) comprise cumulative disorders involving the muscles, ligaments, tendons, cartilage, and the nerves.3–-6 WRMSDs can be attributed directly via surrounding work environment or performance of work tasks.7 In addition, WRMSDs can also be caused by further aggravation or deterioration of existing musculoskeletal conditions due to inconducive working environment.7,8 Over the years, there is a rapid pace of transformation, modernisation, and industrialisation. Hence, the demand for physical occupational load has evolved over time. Manual dependent workers or labourers are expected to work in long hours of static or awkward postures, continuous repetitive movements, rapid work activities, and forceful exertion, which are risk factors for WRMSDs.2,9,10 Hence, WRMSDs were reported to be more predominant in industries which comprise agriculture, forestry and fishing group, construction group as well as healthcare and social work activity group.2

WRMSDs evolve over a period of time and reach a threshold where the affected or injured structures can no longer sustain their adaptive and repair capacities.11 This will then lead to persistent pain (usually severe), which will further limit the daily functions or work tasks of the affected individual.12,13 WRMSDs were responsible for 30% of all work-related illnesses and an estimated 8.9 million working days lost in 2019/2020.2

The International Ergonomics Association (IEA) defines ergonomics or human factors as the scientific field that emphasises the understanding of the relationship between humans and other components of a system, as well as the field that applies information, model, principles, and approaches to designing workstations that enhance human well-being and the overall performance of the system.14 Implementation of workplace ergonomics is obligatory in order to improve the quality, productivity, and workers’ morale, as well as to create a conducive working culture.

Landscaping work, which shares similar job tasks with agricultural workers and gardeners, includes lifting and carrying, stretching, bending over, twisting, and pulling and pushing heavy loads.15 Hence, landscaping work is considered a high-risk industry in the service sector.15 A high proportion of non-fatal injuries were frequently reported among landscape workers.16 The injuries may be due to contact with equipment or objects, fall from elevation, transportation, as well as exposure to harmful substances or environments, and overexertion while working.16,17 Furthermore, many WRMSDs studies have also been conducted among agricultural workers which included plantation workers and farmers as well as gardeners.18–23 The most prevalent WRMSDs were reported in the lower back region (53.3–86.5%) followed by the neck (23.9–85.9%) and shoulder regions (21.6–80.9%).18–23

Therefore, ergonomic risk assessment is deemed necessary among landscape workers who are working in potentially hazardous environments. Furthermore, it is also in accordance with the Occupational, Safety and Health Act (OSHA), which highlighted the responsibility of employers in providing and maintaining the safety, health, and welfare of workers in the working environment.24

Most landscaping workers at universities are involved in tasks that require manual activities. This include sweeping, raking, cleaning up dry leaves, watering the plants, clearing the drains, and trimming hedges and trees in the university grounds. Hence, the landscape workers are also exposed to awkward postures, such as squatting, kneeling, and bending, for long periods of time, and to other ergonomic risk factors that may result in work-related musculoskeletal disorders. This study aimed to determine the prevalence of WRMSDs and to identify the ergonomic risk factors among landscape workers in a university setting in order to address the limited evidence in this area. The data collected will be beneficial for improving work procedures and practices for landscape workers, in accordance with the guidelines of the Department of Safety and Health (DOSH).

Materials and Methods

Study Design and Study Populations

This cross-sectional study, which involved landscape workers who had worked for at least 12 months with no previous work-related musculoskeletal injuries, was conducted at the main campus of a public university in Kota Kinabalu, Sabah. Ethical approval for the study was obtained from the Ethical Committee of the Faculty of Medicine and Health Sciences University Malaysia Sabah (UMS; Approval Code: JKEtika 1/20 (3)). Fifty-five of 60 landscape workers agreed to participate and consented to the study, which provided a 92% response rate.

Research Materials

Assessment of Exposure

For data collection, questionnaires were disseminated to the landscape workers via their supervisor. Nevertheless, since most of the workers were of low level of literacy, direct interviews were conducted by the researcher based on the structured questionnaire and were assisted by translators who spoke the local dialect. The questionnaire comprised four sections; (i) Section A: Sociodemographic…


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