{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T08:31:26Z","timestamp":1786437086331,"version":"build-2736575974"},"reference-count":29,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T00:00:00Z","timestamp":1786406400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Int. J. Environ. Res. Public Health","IJERPH"],"abstract":"<jats:p>This study investigated the complex interfaces between knowledge, attitude and practice (KAP); biomechanical risks; and musculoskeletal disorders (MSDs) among heavy manual handling workers. A cross-sectional study surveyed 99 industrial manual lifting workers within manufacturing factories (mean age: 33.4 \u00b1 7.7 years; mean job experience: 7.95 \u00b1 6.5 years) using a validated online questionnaire assessing demographics, occupational conditions, biomechanical risk, lifting KAP, and MSD prevalence via the Extended Nordic Musculoskeletal Questionnaire. Associations with 12-month and active 7-day MSD prevalence were analyzed using multinomial logistic regression. The 12-month prevalence of MSDs was 56.6%, predominantly affecting the lower back (51.0%). The MSD group reported significantly higher biomechanical risks. Chi-square analysis revealed significant differences in safety practices (p = 0.025), particularly regarding pre-work stretching, load-weight assessment, and overhead lifting. Higher biomechanical risk was significantly associated with 12-month MSDs without 7-day pain (RRR = 1.54, 95% CI: 1.10 to 2.16, p = 0.012). Conversely, greater knowledge demonstrated a significant protective association against 12-month MSDs without 7-day pain (RRR = 0.74, 95% CI: 0.56 to 0.99, p = 0.045). Age-related vulnerability significantly increased active 7-day MSDs. MSD prevalence is driven by cumulative biomechanical hazards. Although knowledge is associated with lower long-term risk, a critical knowledge-to-practice gap exists. Interventions must prioritize workplace ergonomic risk reduction with age-tailored adjustments. These should be integrated with active, practice-based training to foster behavioral modification.<\/jats:p>","DOI":"10.3390\/ijerph23081041","type":"journal-article","created":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T08:09:36Z","timestamp":1786435776000},"page":"1041","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Knowledge-to-Practice Gap in Safe Lifting and Biomechanical Risks as Determinants of Musculoskeletal Disorders in Manual Material Handling"],"prefix":"10.3390","volume":"23","author":[{"given":"Chedsada","family":"Saisombut","sequence":"first","affiliation":[{"name":"Department of Community Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3929-5585","authenticated-orcid":false,"given":"Pheerasak","family":"Assavanopakun","sequence":"additional","affiliation":[{"name":"Department of Community Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand"},{"name":"Environmental and Occupational Medicine Excellence Center, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pevra","family":"Kanta","sequence":"additional","affiliation":[{"name":"Environmental and Occupational Medicine Excellence Center, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0479-4923","authenticated-orcid":false,"given":"Jinjuta","family":"Panumasvivat","sequence":"additional","affiliation":[{"name":"Department of Community Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand"},{"name":"Environmental and Occupational Medicine Excellence Center, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2028","DOI":"10.1002\/art.34347","article-title":"A systematic review of the global prevalence of low back pain","volume":"64","author":"Hoy","year":"2012","journal-title":"Arthritis Rheum."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Li, Y., Zou, C., Guo, W., Han, F., Fan, T., Zang, L., and Huang, G. (2024). Global burden of low back pain and its attributable risk factors from 1990 to 2021: A comprehensive analysis from the global burden of disease study 2021. Front. Public Health, 12.","DOI":"10.3389\/fpubh.2024.1480779"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Shen, L., Cao, W., and Yu, Y. (2025). The burden of low back pain in BRICS: An analysis for the global burden of disease study 2021. Front. Public Health, 13.","DOI":"10.3389\/fpubh.2025.1563260"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1007\/s10926-013-9454-9","article-title":"Prediction of sickness absenteeism, disability pension and sickness presenteeism among employees with back pain","volume":"24","author":"Hagberg","year":"2014","journal-title":"J. Occup. Rehabil."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"453","DOI":"10.5271\/sjweh.4114","article-title":"Occupational mechanical exposures as risk factor for chronic low-back pain: A systematic review and meta-analysis","volume":"49","author":"Jahn","year":"2023","journal-title":"Scand. J. Work Environ. Health"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Greggi, C., Visconti, V.V., Albanese, M., Gasperini, B., Chiavoghilefu, A., Prezioso, C., Persechino, B., Iavicoli, S., Gasbarra, E., and Iundusi, R. (2024). Work-Related Musculoskeletal Disorders: A Systematic Review and Meta-Analysis. J. Clin. Med., 13.","DOI":"10.3390\/jcm13133964"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2368","DOI":"10.1016\/S0140-6736(18)30489-6","article-title":"Prevention and treatment of low back pain: Evidence, challenges, and promising directions","volume":"391","author":"Foster","year":"2018","journal-title":"Lancet"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1001\/jamainternmed.2015.7431","article-title":"Prevention of Low Back Pain: A Systematic Review and Meta-analysis","volume":"176","author":"Steffens","year":"2016","journal-title":"JAMA Intern. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1016\/j.jmpt.2005.01.009","article-title":"Back belt use for prevention of occupational low back pain: A systematic review","volume":"28","author":"Ammendolia","year":"2005","journal-title":"J. Manip. Physiol. Ther."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1146\/annurev.bioeng.4.092101.122107","article-title":"Spine ergonomics","volume":"4","author":"Pope","year":"2002","journal-title":"Annu. Rev. Biomed. Eng."},{"key":"ref_11","first-page":"1415","article-title":"Comparison of physical fitness between rice farmers with and without chronic low back pain: A cross-sectional study","volume":"93","author":"Taechasubamorn","year":"2010","journal-title":"J. Med. Assoc. Thail."},{"key":"ref_12","unstructured":"Rosner, B. (2011). Chapter 7: Hypothesis Testing: Categorical Data\/Estimation of Sample Size and Power for Comparing Two Binomial Proportions. Fundamentals of Biostatistics, Brooks\/Cole. [7th ed.]."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e085123","DOI":"10.1136\/bmjopen-2024-085123","article-title":"Prevalence of musculoskeletal disorders among garment workers: A systematic review and meta-analysis","volume":"15","author":"Gebrye","year":"2025","journal-title":"BMJ Open"},{"key":"ref_14","first-page":"10","article-title":"Prevalence of work-related musculoskeletal disorders in office workers: OSCWE online questionnaire","volume":"3","author":"Aunkhompet","year":"2020","journal-title":"Thai J. Ergon."},{"key":"ref_15","unstructured":"(2021). Ergonomics\u2014Manual Handling\u2014Part 1: Lifting, Lowering and Carrying (Standard No. ISO 11228-1:2021)."},{"key":"ref_16","unstructured":"Laurig, W., and Vedder, J. (2011). Ergonomics. ILO Encyclopaedia of Occupational Health and Safety, International Labour Organization."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Stack, T., Ostrom, L.T., and Wilhelmsen, C.A. (2016). Occupational Ergonomics: A Practical Approach, John Wiley & Sons, Inc.. [1st ed.].","DOI":"10.1002\/9781118814239"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1080\/00140139308967940","article-title":"Revised NIOSH equation for the design and evaluation of manual lifting tasks","volume":"36","author":"Waters","year":"1993","journal-title":"Ergonomics"},{"key":"ref_19","unstructured":"Bloom, B.S., Engelhart, M.D., Furst, E.J., Hill, W.H., and Krathwohl, D.R. (1964). Taxonomy of Educational Objectives, Longmans, Green."},{"key":"ref_20","first-page":"165","article-title":"Musculoskeletal disorders among northeastern construction workers with temporary migration","volume":"22","author":"Saetan","year":"2007","journal-title":"Srinagarind Med. J."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2546","DOI":"10.1007\/s00586-025-08935-5","article-title":"Burden of low-back pain disease caused by occupational ergonomic factors in China from 1990 to 2021 and forecast for 2035: A systematic analysis and comparison with global trends","volume":"34","author":"Yin","year":"2025","journal-title":"Eur. Spine J."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1014","DOI":"10.1136\/annrheumdis-2020-217050","article-title":"Incidence trend of five common musculoskeletal disorders from 1990 to 2017 at the global, regional and national level: Results from the global burden of disease study 2017","volume":"79","author":"Jin","year":"2020","journal-title":"Ann. Rheum. Dis."},{"key":"ref_23","unstructured":"Ministry of Labour (2026, August 01). Ministerial Regulation on the Prescribed Weight for Employee to perform as Employer Required B.E. 2547. Available online: https:\/\/natlex.ilo.org\/dyn\/natlex2\/natlex2\/files\/download\/96390\/THA96390%20ENG.pdf."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Schr\u00f6der, C., and Nienhaus, A. (2020). Intervertebral Disc Disease of the Lumbar Spine in Health Personnel with Occupational Exposure to Patient Handling-A Systematic Literature Review and Meta-Analysis. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17134832"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1007\/s00420-021-01778-9","article-title":"The relationship between low back pain and the basic lumbar posture at work: A retrospective cross-sectional study","volume":"95","author":"Leivas","year":"2022","journal-title":"Int. Arch. Occup. Environ. Health"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1093\/occmed\/kqp127","article-title":"What constitutes effective manual handling training? A systematic review","volume":"60","author":"Clemes","year":"2010","journal-title":"Occup. Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"81","DOI":"10.4103\/jehp.jehp_492_21","article-title":"Effectiveness of training program in manual material handling: A health promotion approach","volume":"11","author":"Jari","year":"2022","journal-title":"J. Educ. Health Promot."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Santos, W., Rojas, C., Isidoro, R., Lorente, A., Dias, A., Mariscal, G., Benlloch, M., and Lorente, R. (2025). Efficacy of Ergonomic Interventions on Work-Related Musculoskeletal Pain: A Systematic Review and Meta-Analysis. J. Clin. Med., 14.","DOI":"10.3390\/jcm14093034"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"103139","DOI":"10.1016\/j.apergo.2020.103139","article-title":"The effectiveness of ergonomic interventions in material handling operations","volume":"87","author":"Wurzelbacher","year":"2020","journal-title":"Appl. Ergon."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/23\/8\/1041\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T08:16:30Z","timestamp":1786436190000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/23\/8\/1041"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,11]]},"references-count":29,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["ijerph23081041"],"URL":"https:\/\/doi.org\/10.3390\/ijerph23081041","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,11]]}}}