{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T15:45:23Z","timestamp":1792165523664,"version":"4.4.0"},"reference-count":53,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2025,5,26]],"date-time":"2025-05-26T00:00:00Z","timestamp":1748217600000},"content-version":"vor","delay-in-days":145,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,1,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Objectives: Firefighters are frequently exposed to psychologically and physically stressful experiences. This volatile occupational environment is thought to contribute to the risk of firefighter musculoskeletal disorders (MSDs). However, investigations of firefighter MSDs are limited, and to our knowledge, have not been collectively examined. The purpose of this novel systematic review was to systematically identify, critically appraise, and synthesize evidence regarding the relationship between MSDs and personal, physical, and psychosocial factors among career firefighters to guide future study directions.<\/jats:p>\n               <jats:p>Methods: Five electronic databases (MEDLINE, CINAHL, SPORTDiscus, APA PsychInfo, PubMed) were searched from inception to December 12, 2024, which yielded 741 results. This review followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines and used the AXIS (Assess the Quality of Cross-Sectional Studies) tool.<\/jats:p>\n               <jats:p>Results: The final review included 20 cross-sectional studies (AXIS scores 12-18). Of those, 19 examined physical factor(s), and 16 examined psychosocial factor(s). The overall evidence suggests a positive relationship between firefighter MSD reports and body mass index (BMI), occupational stress, and depression. A negative relationship to physical activity engagement was consistently observed.<\/jats:p>\n               <jats:p>Conclusions: Body mass index , physical activity, and occupational stress were the most consistently examined factors related to firefighter MSDs. Odds of MSD occurrences were positively related to occupational stress and BMI, and negatively related to physical activity engagement; therefore, future investigations can focus primarily on these factors in relation to MSD risk. The establishment of reliable and culturally appropriate MSD report forms among firefighters is warranted as data collected were heterogeneous and not directly comparable. Finally, this report suggests that prospective examinations of both physical and psychosocial factors related to firefighter MSDs are needed.<\/jats:p>","DOI":"10.1093\/joccuh\/uiaf028","type":"journal-article","created":{"date-parts":[[2025,5,26]],"date-time":"2025-05-26T14:59:48Z","timestamp":1748271588000},"source":"Crossref","is-referenced-by-count":4,"title":["Biopsychosocial and physical factors associated with firefighter musculoskeletal disorders: a systematic review"],"prefix":"10.1093","volume":"67","author":[{"given":"Jennifer","family":"Tinsley Kubala","sequence":"first","affiliation":[{"name":"Orthopedic Surgery and Sports Medicine, University of Kentucky , 740 S. Limestone, Lexington, KY 40536 ,","place":["United States"]},{"name":"Lexington Fire Department , Lexington, KY 40504 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Kleis","sequence":"additional","affiliation":[{"name":"Department of Kinesiology, Master Science Athletic Training Program , McPhee Building 215, University of Wisconsin Eau Claire, Eau Claire, WI 54702-4004 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johanna","family":"Hoch","sequence":"additional","affiliation":[{"name":"Athletic Training and Clinical Nutrition, University of Kentucky , 900 South Limestone Street, Wethington Building, Lexington, KY 40536 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,5,26]]},"reference":[{"issue":"3","key":"2025062701303811800_ref1","doi-asserted-by":"publisher","first-page":"167","DOI":"10.1249\/JSR.0b013e31821a9fec","article-title":"Firefighter fitness: improving performance and preventing injuries and fatalities","volume":"10","author":"Smith","year":"2011","journal-title":"Curr Sports Med Rep"},{"issue":"8","key":"2025062701303811800_ref2","doi-asserted-by":"publisher","first-page":"583","DOI":"10.1093\/occmed\/kqu133","article-title":"Physical and psychological determinants of injury in Ontario forest firefighters","volume":"64","author":"Gordon","year":"2014","journal-title":"Occup Med (Lond)"},{"issue":"4","key":"2025062701303811800_ref3","doi-asserted-by":"publisher","first-page":"341","DOI":"10.70252\/FCDC4147","article-title":"Tactical athletes: an integrated approach to understanding and enhancing the health and performance of firefighters-in-training","volume":"8","author":"Gnacinski","year":"2015","journal-title":"Int J Exerc Sci"},{"issue":"1","key":"2025062701303811800_ref4","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1186\/s13643-020-01367-w","article-title":"Interventions for the prevention and management of occupational stress injury in first responders: a rapid overview of reviews","volume":"9","author":"Antony","year":"2020","journal-title":"Syst Rev"},{"issue":"2","key":"2025062701303811800_ref5","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1177\/2165079917709020","article-title":"Predictors of back pain in firefighters","volume":"66","author":"Damrongsak","year":"2018","journal-title":"Workplace Health Saf"},{"key":"2025062701303811800_ref6","article-title":"United States firefighter injuries in 2020","author":"Campbell","year":"2021","journal-title":"NFPA J"},{"key":"2025062701303811800_ref7","article-title":"United States firefighter injuries in 2019","author":"Campbell","year":"2020"},{"key":"2025062701303811800_ref8","article-title":"United States firefighter injuries 2021","author":"Campbell","year":"2022"},{"issue":"1","key":"2025062701303811800_ref9","doi-asserted-by":"publisher","first-page":"272","DOI":"10.1080\/10803548.2023.2294627","article-title":"The global prevalence of musculoskeletal disorders among firefighters: a systematic review and meta-analysis","volume":"30","author":"Khoshakhlagh","year":"2024","journal-title":"Int J Occup Saf Ergon"},{"issue":"6","key":"2025062701303811800_ref10","doi-asserted-by":"publisher","first-page":"373","DOI":"10.1007\/s00420-004-0537-y","article-title":"Risk of health complaints and disabilities among Dutch firefighters","volume":"77","author":"Bos","year":"2004","journal-title":"Int Arch Occup Environ Health"},{"issue":"1","key":"2025062701303811800_ref11","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1136\/injuryprev-2016-042213","article-title":"The benefits of data linkage for firefighter injury surveillance","volume":"24","author":"Widman","year":"2018","journal-title":"Inj Prev"},{"issue":"20","key":"2025062701303811800_ref12","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph16203931","article-title":"A profile of injuries sustained by firefighters: a critical review","volume":"16","author":"Orr","year":"2019","journal-title":"Int J Environ Res Public Health"},{"issue":"2","key":"2025062701303811800_ref13","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1249\/JSR.0000000000000684","article-title":"Optimizing health, wellness, and performance of the tactical athlete","volume":"19","author":"Wise","year":"2020","journal-title":"Curr Sports Med Rep"},{"key":"2025062701303811800_ref14","article-title":"Standard 1001 \u2013 standard for firefighter professional qualifications, essential job tasks and job performance requirements","author":"National Fire Protection Association","year":"2019"},{"issue":"1","key":"2025062701303811800_ref15","doi-asserted-by":"publisher","first-page":"54","DOI":"10.1177\/0706743717723825","article-title":"Mental disorder symptoms among public safety personnel in Canada","volume":"63","author":"Carleton","year":"2018","journal-title":"Can J Psychiatr"},{"issue":"1","key":"2025062701303811800_ref16","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1108\/ijes-10-2016-0020","article-title":"Firefighters and traumatic stress: a review","volume":"6","author":"Fraess-Phillips","year":"2017","journal-title":"Int J Emerg Serv"},{"issue":"Suppl 1","key":"2025062701303811800_ref17","first-page":"S14","article-title":"Resilience among first responders","volume":"8","author":"Pietrantoni","year":"2008","journal-title":"Afr Health Sci"},{"issue":"1","key":"2025062701303811800_ref18","doi-asserted-by":"publisher","first-page":"4649","DOI":"10.1038\/s41598-024-55468-w","article-title":"Occupational stress and musculoskeletal disorders in firefighters: the mediating effect of depression and job burnout","volume":"14","author":"Khoshakhlagh","year":"2024","journal-title":"Sci Rep"},{"key":"2025062701303811800_ref19","doi-asserted-by":"publisher","first-page":"128","DOI":"10.1016\/j.jad.2014.02.031","article-title":"Resilience buffers the impact of traumatic events on the development of PTSD symptoms in firefighters","volume":"162","author":"Lee","year":"2014","journal-title":"J Affect Disord"},{"issue":"6","key":"2025062701303811800_ref20","doi-asserted-by":"publisher","first-page":"321","DOI":"10.1111\/j.1467-8721.2007.00529.x","article-title":"Structural and functional neuroplasticity in relation to traumatic stress","volume":"16","author":"Kolassa","year":"2007","journal-title":"Curr Dir Psychol Sci"},{"issue":"4","key":"2025062701303811800_ref21","doi-asserted-by":"publisher","first-page":"573","DOI":"10.1080\/00140139.2021.1974103","article-title":"The impaired healing hypothesis: a mechanism by which psychosocial stress and personal characteristics increase MSD risk?","volume":"65","author":"Gallagher","year":"2022","journal-title":"Ergonomics"},{"issue":"1","key":"2025062701303811800_ref22","doi-asserted-by":"publisher","first-page":"52","DOI":"10.1186\/s12998-021-00409-x","article-title":"Risk factors for low back pain in active military personnel: a systematic review","volume":"29","author":"To","year":"2021","journal-title":"Chiropr Man Ther"},{"issue":"8","key":"2025062701303811800_ref23","doi-asserted-by":"publisher","DOI":"10.1111\/spc3.12328","article-title":"Rethinking the biopsychosocial model of health: understanding health as a dynamic system","volume":"11","author":"Lehman","year":"2017","journal-title":"Soc Personal Psychol Compass"},{"issue":"12","key":"2025062701303811800_ref24","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2016-011458","article-title":"Development of a critical appraisal tool to assess the quality of cross-sectional studies (AXIS)","volume":"6","author":"Downes","year":"2016","journal-title":"BMJ Open"},{"key":"2025062701303811800_ref25","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1016\/j.paid.2019.02.027","article-title":"A systematic literature review of the relationship between dark personality traits and antisocial online behaviours","volume":"144","author":"Moor","year":"2019","journal-title":"J Individ Differ"},{"issue":"1","key":"2025062701303811800_ref26","doi-asserted-by":"publisher","first-page":"59","DOI":"10.3122\/jabfm.17.1.59","article-title":"Strength of recommendation taxonomy (SORT): a patient-centered approach to grading evidence in the medical literature","volume":"17","author":"Ebell","year":"2004","journal-title":"J Am Board Fam Med"},{"issue":"3","key":"2025062701303811800_ref27","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1300\/j094v10n03_04","article-title":"Neck, back, and shoulder pain complaints in urban firefighters: the benefits of aerobic exercise","volume":"10","author":"Beaton","year":"2002","journal-title":"J Musculoskelet Pain"},{"issue":"2","key":"2025062701303811800_ref28","doi-asserted-by":"publisher","first-page":"339","DOI":"10.1016\/j.ajem.2012.08.032","article-title":"Epidemiology of injuries to wildland firefighters","volume":"31","author":"Britton","year":"2013","journal-title":"Am J Emerg Med"},{"issue":"8","key":"2025062701303811800_ref29","doi-asserted-by":"publisher","first-page":"634","DOI":"10.1097\/jom.0000000000001918","article-title":"Injury correlates among a national sample of women in the US fire service","volume":"62","author":"Hollerbach","year":"2020","journal-title":"J Occup Environ Med"},{"issue":"8","key":"2025062701303811800_ref30","doi-asserted-by":"publisher","first-page":"1505","DOI":"10.1002\/oby.20436","article-title":"Obesity and incident injury among career firefighters in the central United States","volume":"21","author":"Jahnke","year":"2013","journal-title":"Obesity (Silver Spring)"},{"issue":"4","key":"2025062701303811800_ref31","doi-asserted-by":"publisher","first-page":"e150","DOI":"10.1097\/jom.0000000000001559","article-title":"Sleep, obesity, and injury among US male career firefighters","volume":"61","author":"Kaipust","year":"2019","journal-title":"J Occup Environ Med"},{"issue":"1","key":"2025062701303811800_ref32","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1093\/occmed\/kqv144","article-title":"The relationship between burnout, PTSD symptoms and injuries in firefighters","volume":"66","author":"Katsavouni","year":"2016","journal-title":"Occup Med (Lond)"},{"issue":"1","key":"2025062701303811800_ref33","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1186\/2052-4374-25-9","article-title":"Relationship between occupational stress and work-related musculoskeletal disorders in Korean male firefighters","volume":"25","author":"Kim","year":"2013","journal-title":"Ann Occup Environ Med"},{"issue":"11","key":"2025062701303811800_ref34","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2016-012002","article-title":"Association between job stress and occupational injuries among Korean firefighters: a nationwide cross-sectional study","volume":"6","author":"Kim","year":"2016","journal-title":"BMJ Open"},{"issue":"2","key":"2025062701303811800_ref35","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1108\/IJWHM-08-2018-0111","article-title":"Work demand, stress and work-related musculoskeletal disorders among emergency workers","volume":"12","author":"Kodom-Wiredu","year":"2019","journal-title":"Int J Workplace Health Manag"},{"issue":"5","key":"2025062701303811800_ref36","doi-asserted-by":"publisher","first-page":"579","DOI":"10.1097\/JOM.0b013e318249202d","article-title":"Body mass index as a predictor of firefighter injury and workers' compensation claims","volume":"54","author":"Kuehl","year":"2012","journal-title":"J Occup Environ Med"},{"issue":"3","key":"2025062701303811800_ref37","doi-asserted-by":"publisher","first-page":"229","DOI":"10.1037\/1076-8998.6.3.229","article-title":"Correlates of work injury frequency and duration among firefighters","volume":"6","author":"Liao","year":"2001","journal-title":"J Occup Health Psychol"},{"issue":"6","key":"2025062701303811800_ref38","doi-asserted-by":"publisher","first-page":"291","DOI":"10.1177\/2165079917740595","article-title":"Characteristics and predictors of occupational injury among career firefighters","volume":"66","author":"Phelps","year":"2018","journal-title":"Workplace Health Saf"},{"issue":"3","key":"2025062701303811800_ref39","doi-asserted-by":"publisher","first-page":"341","DOI":"10.13075\/ijomeh.1896.01268","article-title":"Occupational stress and musculoskeletal symptoms in firefighters","volume":"32","author":"Soteriades","year":"2019","journal-title":"Int J Occup Med Environ Health"},{"issue":"5","key":"2025062701303811800_ref40","doi-asserted-by":"publisher","first-page":"608","DOI":"10.1123\/jsr.2018-0284","article-title":"Ankle sprains risk factors in a sample of French firefighters: a preliminary prospective study","volume":"29","author":"Vaulerin","year":"2020","journal-title":"J Sport Rehabil"},{"key":"2025062701303811800_ref41","doi-asserted-by":"publisher","first-page":"131","DOI":"10.1016\/j.apergo.2015.12.007","article-title":"Physical exercise and burnout facets predict injuries in a population-based sample of French career firefighters","volume":"54","author":"Vaulerin","year":"2016","journal-title":"Appl Ergon"},{"issue":"6","key":"2025062701303811800_ref42","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.62189","article-title":"Comparison between disability, physical performance, and other biopsychosocial factors in full-duty career firefighters working with and without current low back pain","volume":"16","author":"Mayer","year":"2024","journal-title":"Cureus"},{"issue":"1","key":"2025062701303811800_ref43","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1002\/ajim.22929","article-title":"The relationship between physical fitness and occupational injury in emergency responders: a systematic review","volume":"62","author":"Lentz","year":"2019","journal-title":"Am J Ind Med"},{"issue":"10","key":"2025062701303811800_ref44","doi-asserted-by":"publisher","first-page":"963","DOI":"10.1016\/j.jsams.2021.03.016","article-title":"Musculoskeletal injuries in military personnel\u2014descriptive epidemiology, risk factor identification, and prevention","volume":"24","author":"Lovalekar","year":"2021","journal-title":"J Sci Med Sport"},{"issue":"4","key":"2025062701303811800_ref45","doi-asserted-by":"publisher","first-page":"495","DOI":"10.3233\/WOR-192963","article-title":"Physical employment standards, physical training and musculoskeletal injury in physically demanding occupations","volume":"63","author":"Drain","year":"2019","journal-title":"Work"},{"issue":"8-9","key":"2025062701303811800_ref46","doi-asserted-by":"publisher","first-page":"625","DOI":"10.1093\/occmed\/kqaa015","article-title":"Alcohol use and mental health symptoms in female firefighter recruits","volume":"69","author":"Gulliver","year":"2019","journal-title":"Occup Med (Lond)"},{"issue":"3","key":"2025062701303811800_ref47","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph15030464","article-title":"Generalized unsafety theory of stress: unsafe environments and conditions, and the default stress response","volume":"15","author":"Brosschot","year":"2018","journal-title":"Int J Environ Res Public Health"},{"issue":"Pt B","key":"2025062701303811800_ref48","doi-asserted-by":"publisher","first-page":"287","DOI":"10.1016\/j.neubiorev.2016.07.019","article-title":"Exposed to events that never happen: generalized unsafety, the default stress response, and prolonged autonomic activity","volume":"74","author":"Brosschot","year":"2017","journal-title":"Neurosci Biobehav Rev"},{"key":"2025062701303811800_ref49","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1016\/j.janxdis.2016.04.012","article-title":"The default response to uncertainty and the importance of perceived safety in anxiety and stress: an evolution-theoretical perspective","volume":"41","author":"Brosschot","year":"2016","journal-title":"J Anxiety Disord"},{"issue":"2","key":"2025062701303811800_ref50","doi-asserted-by":"publisher","first-page":"e12894","DOI":"10.2196\/12894","article-title":"Resilience@work mindfulness program: results from a cluster randomized controlled trial with first responders","volume":"21","author":"Joyce","year":"2019","journal-title":"J Med Internet Res"},{"issue":"1","key":"2025062701303811800_ref51","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1027\/1016-9040\/a000124","article-title":"Psychological resilience","volume":"18","author":"Fletcher","year":"2013","journal-title":"Eur Psychol"},{"issue":"Pt B","key":"2025062701303811800_ref52","doi-asserted-by":"publisher","first-page":"119","DOI":"10.1016\/j.expneurol.2016.07.002","article-title":"Understanding resilience: new approaches for preventing and treating PTSD","volume":"284","author":"Horn","year":"2016","journal-title":"Exp Neurol"},{"issue":"2","key":"2025062701303811800_ref53","doi-asserted-by":"publisher","first-page":"75","DOI":"10.3928\/19425864-20191112-01","article-title":"Perceived barriers to musculoskeletal injury and illness reporting in the fire service","volume":"13","author":"Potts","year":"2021","journal-title":"Athl Train Sports Health Care"}],"container-title":["Journal of Occupational Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/joh\/advance-article-pdf\/doi\/10.1093\/joccuh\/uiaf028\/63356068\/uiaf028.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/joh\/article-pdf\/67\/1\/uiaf028\/63356068\/uiaf028.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/joh\/article-pdf\/67\/1\/uiaf028\/63356068\/uiaf028.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,27]],"date-time":"2025-06-27T05:30:42Z","timestamp":1751002242000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/joh\/article\/doi\/10.1093\/joccuh\/uiaf028\/8149217"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1]]},"references-count":53,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2025,1,7]]}},"URL":"https:\/\/doi.org\/10.1093\/joccuh\/uiaf028","relation":{},"ISSN":["1348-9585"],"issn-type":[{"value":"1348-9585","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,1]]},"published":{"date-parts":[[2025,1]]},"article-number":"uiaf028"}}