Sources could be subdivided into those supplying whole-population statistics, data from selected public sector employments, and employers’ views (rather than numerical absence data).
The Labour Force Survey (LFS), which is managed by the ONS, collects information quarterly from samples of 50-60,000 private households in Great Britain. In the two-year period ending June 2006, the household-specific response rate approached two-thirds. Interviewers can accept proxy responses if the respondent is unavailable (empirical evidence suggests the approach is robust).
Questions are posed about the days that an individual has been absent from work because of illness or injury in the week of inquiry. MSDs are classified as affecting arms or hands, legs or feet, and back or neck. Respondents absent at the start or end of the reference week may have an unknown preceding or subsequent spell of absence. Thus, while providing an indication of period prevalence (MSD-related sickness absence in an index week) and the percentage of working days lost because of MSDs, the data are uninformative as regards the duration of spells of absence.
shows that, amongst a nationally representative population sample who took sickness absence in the previous week, about 30% cited musculoskeletal problems as the main reason [6
Table 1 Proportion of sickness absence in the reference week attributed to musculoskeletal problems: Analysis by main health problem and site(s) affected, Oct – Dec 2009 (from the Labour Force Survey )
Since 1990, HSE has commissioned supplementary questions in the LFS, to track work-related illness and injury. The Workplace Injury survey module
, added in 1990, was supplanted in 2003/4 by the Self-reported Work-related Illness (SWI) survey module
– with broader coverage of health. The SWI module is administered annually to adults from the LFS who are or have been employed. Individuals answer a screening question: “Within the last 12 months have you suffered from any illness, disability or other physical or mental problem that was caused or made worse by your job or work done in the past?” Those responding positively are asked how many work-related illnesses they have had. Subsequent inquiries focus on the most serious work-ascribed illness, and respondents who have worked in the past 12 months are asked how much time they have taken off work during that period because of their illness. Thus, assuming that respondents accurately recall sickness absence and the underlying health problem, the data provide a lower limit on the burden of all sickness absence from MSDs, statistics being published for sickness absence attributed to MSDs of back; neck or upper limb; lower limb, and all sites combined ( [7
Figure 1 Trends in sickness absence in the Labour Force SWI Survey 
The SWI estimated that an annual 9.26 million working days were lost in 2008/9 from self-reported work-ascribed MSDs, with back pain contributing 3.51 million lost days, neck or upper limb pain 3.75 million days, and lower limb pain 1.99 million days. Relative to 2001-2, this represents a decline of 22% overall, the fall being greatest for back pain (36%) and least for arm or neck pain (5%). The average days lost per case also declined – from 19.3 days/year in 2001-2 to 17.2 days/year in 2008-9, a fall of 11%, with a greater reduction (17%) for back pain. Numbers of cases and spells per case are not reported routinely, but the steeper decline in total days of absence than in days lost/case implies a fall in the number of cases, as well as briefer illness episodes.
In 1995/6, HSE estimated that the 9.5 million working days lost to work-related musculoskeletal disorders cost society £5.7 billion (£8 billion adjusted to 2009 prices). In principle, such costs can be estimated for other periods, but no serial index of costs is routinely published.
The Health Occupation Reporting network, general practitioner extension (THOR-GP) is an HSE-sponsored surveillance scheme, initiated in 2005, and administered by the Centre for Occupational and Environmental Health at the University of Manchester. A panel of volunteers (some 270 general practitioners with supplementary training in occupational medicine) identifies new cases of work-related ill health from their clinical practice. Reporters classify cases into disease categories and record their age, sex, job, industry, exposure, and sickness absence.
Data are available on MSD-related sickness absence which, in the reporter’s judgement, are caused or exacerbated by work [8
]. An audit has revealed “a considerable level of underreporting” of sickness absence [9
]: THOR-GP documents an individual’s initial
spell of absence, but not routinely their subsequent spells. Detailed follow-up in a sample of cases has suggested that only about 40% of the total duration of absence is captured (J Hodgson, personal communication). In 2009, absence data were not published by diagnostic subcategory of MSD.
During 2006-08, the annual incidence of new GP consultations for work-related MSDs was estimated as 830 per 100,000 working population, with 43% of the consultations resulting in sickness certification – a rate of 357 spells per 100,000 workers per year. As each certificate was issued for an average of 9.7 days, the estimated annual loss from certified absence for work-related MSDs (not allowing for underreporting) was 3,462 days per 100,000 workers, or 2.26 million lost days across Great Britain.
The annual estimate of days lost from SWI −9.67 million for 2005/6 to 2007/8 [7
] – is >4 times that from THOR-GP, in part because of the under-reporting mentioned and in part because SWI counts total sickness absence, including uncertified spells. Other factors might also contribute to the discrepancy, such as differences in attribution between doctor and patient.
The Department for Work and Pensions (DWP) collates national statistics on social security benefit, and sponsors internet tabulation tools and a Work and Pensions Longitudinal Study (WPLS), based on all benefit recipients, with further detail published for a 5% sub-sample.
Data on caseload of Incapacity Benefit (IB) are available from 1999 for the WPLS and from 1995 for the 5% sub-sample [10
]. These identify cases arising from MSDs but do not distinguish sub-diagnoses. To be counted, recipients must be below state pension age when they fell ill, and most need to have paid qualifying national insurance contributions and been off sick or unable to work for ≥ 28 weeks. In 2008, 430,000 adults were in receipt of IB for a musculoskeletal reason, 59% of whom had received benefits for ≥5 years (). The caseload has fallen over the past decade and was 23% lower in 2008 than 2004, in accord with time trends in MSD-related absence estimated by the SWI.
Table 2 Caseload on Incapacity Benefit because of “diseases of the musculoskeletal system and connective tissues”, by duration of current claim 
The DWP also commissions ad hoc research based on its client populations. One example concerned structured interviews with 1,843 people who had claimed IB in the previous three months (47% response) [11
]. Among respondents reporting a disability, the leading sites affected included the legs or feet (29%), the neck, shoulders or back (27%), and the arms or hands (19%). These problems ranked third, fourth and fifth among 17 non-mutually exclusive categories of disability.
The Cabinet Office
collected data on total sickness absence, classified by ICD-9 diagnosis, across the Civil Service during 2004, 2005, 2005/6 and 2006/7. In 2006/7, 115 departments participated (almost all) [12
]. Some 4.1 million working days were lost from sickness absence of all causes (in 685,000 spells at an average of 6.01 days/spell). MSDs caused 492,000 lost days, 12% of the total (in 51,000 spells). The proportion of lost days attributed to MSDs in large government departments was almost double that in small and ‘micro’ departments (). The total cost of absence was estimated at £393 million, the MSD-related contribution being £47 million.
Table 3 Working days lost across the Civil Service in the 2006/7 financial year, overall and because of musculoskeletal-related diagnoses  The Local Government Employers Association
(LGE) has issued several reports on sickness absence in local government and social services [13
]. Its 2004/2005 survey covered 107 unitary and county authorities across England and Wales (62% response), and that in 2006/2007 covered 143 local authorities (35% response). The surveys collected data on days lost per employee and converted this to an absence rate reflecting the proportion of working time lost. Similar methods were used in a survey of social service departments in 105 authorities (61% response).
MSDs were categorised into back and other musculoskeletal problems, with data supplied on the median proportion (across authorities) of all days lost and the median proportions of short- and long-term absence spells attributed to MSDs (). These indicate the relative importance of MSDs among other causes of absence but do not quantify lost work time.
Table 4 Proportion of sickness absence days and spells attributed to musculoskeletal causes across local government and social services [13,14]
Across local government and social services, about 9% of all sick leave days were attributed to back pain and another 12-14% to other MSDs. Thus, in both local and in central government, MSDs are leading causes of sickness absence.
conducts an annual survey of absence management, polling human resources (HR) professionals across a range of industrial sectors. Sampling methods are not described. In 2009, 642 replies (5% response) were received from organisations employing >1.9 million people [15
]. Information was obtained on causes of short-term and long-term sickness absence, with findings presented overall and by industrial sector for 13 causes of sick leave.
Absence data, separately distinguishable for back pain and other MSDs, are shown in . Information is limited to proportions of respondents citing these as major contributory causes of absence. The survey highlights the relative importance of back pain as a contributory factor as judged by HR professionals; but offers no quantitative data on the number or duration of absence spells, or working time lost. Many respondents cited MSDs amongst the leading causes of sickness absence, both in manual and in non-manual workers.
Table 5 Proportions of respondents citing musculoskeletal disorders as a major factor in sickness absence (CIPD Annual Survey Report, 2009 - Absence Management ) The CBI
(now CBI/AXA) Absence and Labour Turnover Survey has been conducted annually since 1987. In 2008, the survey was completed by managers and HR professionals from 503 private and public sector organisations, employing >1 million workers [16
]. The sampling process is not described. Response rates have run at about 5% in recent times.
In 2008, information was presented on 10 leading causes of short-term and long-term sickness absence, which included the categories “back pain” and “other MSDs” (). Again, details were limited to the proportions of managers citing these as leading causes of short or long-term sickness, and no quantitative data were provided on number or duration of absence spells, or work time lost. The survey estimated an average direct cost to the employer of all sickness absence of £517 per employee/year (salary costs, replacement costs such as agency staff) or 3.1% of payroll; indirect costs, like reduced customer satisfaction, were put at £263 per employee/year. MSD-related absences were not costed separately.
Table 6 Proportions of respondents citing musculoskeletal disorders as a causal factor in sickness absence (CBI/AXA Absence and Labour Turnover Survey, 2008 ) EEF The manufacturers’ organisation
, whose members are drawn from manufacturing, engineering and technology-based companies, conducts annual surveys on sickness absence and labour turnover. In its 2010 report, responses were analysed from 498 member organisations with 99,591 employees (20% response) [17
]. Most respondents (79%) came from small or medium-sized organisations.
Absence rates and total days lost were estimated by industry, social class and size of employer. Information on absence by cause, however, was restricted to questions seeking the three main causes of short-term and long-term absence. “Back pain and other joint/muscular problems” was cited as the second most common cause of both short- and long-term absence.
The CIPD (), CBI/AXA (), and EEF surveys have different sampling frames, but have generated similar rankings by managers, a perspective shared with managers from local government and social services ().
Recent EEF surveys have recorded a downward trend in companies citing back pain as a leading cause, but no similar trend for other MSDs – perhaps in part because medical guidance from the 1990s has improved the management of back pain.