Biopsychosocial and physical factors associated with firefighter musculoskeletal disorders: a systematic review

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. 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. 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. 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.