Relationships among work schedules, sleep quality, and functional disability of nursing home employees

Background: Work-related musculoskeletal disorders (MSDs) are a leading cause of pain and disability, which are particularly high among nursing home employees. There is a known relationship between MSD pain and sleep quality, but the contribution of irregular work schedules and sleep quality to musculoskeletal functional disability has not been well studied.

Methods: Questionnaires were collected from employees in 24 nursing homes. Work schedules included shift work patterns and length, and work hours per two weeks. Sleep quality was assessed from sleep duration, quality, insufficiency, and the number of sleep periods per day. Functional disability was assessed using the QuickDASH for upper extremities and WOMAC for lower extremities.

Results: Among 2,642 employees, getting sleep at two or more different times, short sleep duration, poor sleep quality, and sleep insufficiency were significantly associated with more functional disability in upper and lower extremities. Shift length of >8 hours was associated with less functional disability in upper and lower extremities. However, functional disability was not associated with shift work or the number of work hours per two weeks. For the most part, these associations held after adjustment for several demographic factors.

Conclusions: Longer shifts, sleep-wake patterns, and sleep quality were associated cross-sectionally with functional disability of nursing home employees. Longitudinal studies are needed to examine the causal relationships between sleep quality and functional disability with clarification of the role of work schedules. Future interventions to modify work schedules and promote sleep quality may benefit employees' musculoskeletal health.