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Introduction: The combination at work of physical activity behaviours (e.g. sitting, standing, and physical activity) and psychosocial factors (e.g. influence and leadership quality) may be more important for preventing work-related pain than each of the exposures isolated (i.e., sitting or influence at work). However, this needs to be tested using accurate measurements of physical behaviours. We aimed to investigate the independent and combined associations of physical behaviours and psychosocial factors with pain in a sample of eldercare workers with high occurrence of pain.

Methods: We analysed cross-sectional data on 191 eldercare workers in a Swedish municipality. Participants responded to a web-survey and took part in technical measurements of physical behaviours using thigh-worn accelerometers over 7 days. We determined the proportion of time spent in sitting, standing and active behaviours during working hours for each participant. We then used the Aitchison distance to calculate the closeness (on a scale from 0 “worst possible” to 100 “ideal”) to the composition recommended by the EU (60%,30%,10% for sitting, standing and active, respectively). Leadership quality and influence at work were assessed using COPSOQIII. Pain intensity (0-10 scale) and worsening of pain due to work (0-5 scale) were used as outcomes in MANCOVA models with closeness and psychosocial factors as predictors.

Results: We found that being closer to the recommended composition of sitting, standing and being active at work was associated with lower pain intensity (F=6.3, p=0.01) and less worsening of pain due to work (F=9.2, p=0.003), independent of leadership quality and influence at work. We found no statistically significant interactions between closeness and psychosocial factors regarding these outcomes, but both higher leadership quality and influence at work showed associations with lower pain.

Discussion: Physical behaviours and psychosocial factors at work were independently associated with pain in eldercare workers, while combining the exposures did not contribute to any additional explained variance in pain. These results should be interpreted with caution due to the cross-sectional design and risk of confounding by non-measured factors.

Conclusion: Musculoskeletal pain in eldercare workers was associated with the composition of sitting, standing and active, expressed in terms of closeness to EU guidelines, and physical and psychosocial exposures did not interact. Further research is required to understand the effects on musculoskeletal health of combining physical and psychosocial exposures, including their temporal patterns, in various occupational settings.