ArticleFrontiers in public health2026
Impact of sleep quality on work-related musculoskeletal disorders among nurses: a structural equation model integrating psychosocial factors.
Article in Frontiers in public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background and objective: Work-related musculoskeletal disorders (WMSDs) are highly prevalent among nurses and threaten workforce stability. Although sleep disturbance is known to be associated with WMSDs, the psychosocial pathways underlying this relationship remain poorly understood. This study aims to examine whether sense of agency and perceived social support mediate the relationship between sleep quality and WMSDs among hospital nurses, using a structural equation modeling approach. Methods: A convenience sample of staff nurses was recruited from six tertiary hospitals in three Chinese cities. Participants self-reported sociodemographics, the Pittsburgh Sleep Quality Index (PSQI), sense of personal control, perceived social support, and the 12-month prevalence/number of WMSDs. Structural equation modeling with maximum likelihood estimation was constructed to examine the hypothesized pathways, and bias-corrected bootstrap analysis was conducted to analyze the mediating effect of the sense of agency and perceived social support between sleep quality and the number of WMSDs. Results: Our study included information from 1,388 nurses working in clinical settings. After controlling the factors of gender, length of service, night shift, frequent trunk flexion, frequent heavy lifting, and perceived work fatigue, the PSQI of nurses showed a direct negative association with the sense of agency and perceived social support. Perceived social support had a direct positive impact on the sense of agency, and perceived social support and agency had a direct negative impact on the number of WMSDs in nurses ( Conclusion: Even after accounting for established ergonomic and occupational covariates, poor sleep quality was not only directly associated with a higher number of WMSD sites among nurses but also showed an indirect association with WMSDs through lower sense of agency and perceived social support. Interventions that protect and bolster these psychosocial resources should be embedded within integrated musculoskeletal-health frameworks addressing biological, psychological, and social determinants.
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