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This cross-sectional study assessed 405 male KSRTC drivers across 14 Kerala districts using standardized Nordic musculoskeletal measures, Borg CR-10 body discomfort ratings, the Epworth Sleepiness Scale, and structured exposure data. The lumbar back showed the highest 12-month prevalence (71.9%), with substantial multi-region comorbidity. Epworth scores correlated positively with discomfort severity, and logistic models linked shorter nightly sleep to higher lumbar prevalence, while BMI predicted lumbar severity. The observed musculoskeletal burden was far higher than general-population low back pain, supporting an ergonomic contribution to road safety risk.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/research-report/","Research & 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Linking Ergonomic Strain to Road Safety Risk  \nARUN CHAND  \nSchool of Engineering, Cochin University of Science And Technology, Kerala, India  \n[https://orcid.org/0000-0003-4158-9133](https://orcid.org/0000-0003-4158-9133)  \nA B Bhasi  \nSchool of Engineering, Cochin University of Science And Technology, Kerala, India  \nResearch Article  \nKeywords: Musculoskeletal disorders, Bus drivers, Nordic Musculoskeletal Questionnaire, Epworth Sleepiness Scale, Occupational ergonomics, KSRTC, Kerala, Road safety  \nPosted Date: July 7th, 2026  \nDOI: [https://doi.org/10.21203/rs.3.rs-10254546/v1](https://doi.org/10.21203/rs.3.rs-10254546/v1)  \nLicense: 􀁱 􀅏 This work is licensed under a Creative Commons Attribution 4.0 International License.  \nRead Full License  \nAdditional Declarations: The authors declare no competing interests.  \nAbstract  \nWork-related musculoskeletal disorders and excessive daytime sleepiness in professional driving populations remain under-documented in Indian state-operated road transport, even as ergonomic factors continue to feature in heavy-duty vehicle accident causation. This cross-sectional study assessed 405 male drivers employed by the Kerala State Road Transport Corporation across 14 districts, using the Standardised Nordic Musculoskeletal Questionnaire, the Body Discomfort Chart on the Borg CR-10 scale, the Epworth Sleepiness Scale, and a structured exposure survey. The lumbar back recorded the highest 12-month prevalence at 71 .9%(95% CI 67.3 to 76 .0), with lifetime prevalence at 88. 1% and 7-day acute symptoms in 16.8%, followed by shoulder 50 . 6%, neck 49 . 6%, and knee 47.4% . The mean number of concurrent body regions affected was 3.39 (SD 1. 69), and 66.4% of drivers reported disorders in three or more regions. The mean Epworth score was 10.64 (SD 4 .47), with 48.4% of drivers in the mildly excessive sleepiness category or higher. After Benjamini-Hochberg correction, Spearman correlations confirmed positive associations between Epworth scores and discomfort severity in seven of nine body regions, strongest at the shoulder (r = 0 .268, p \u003C 0 .001) and neck (r = 0 .240, p \u003C 0 .001) . Multivariable logistic regression for lumbar 12-month prevalence identified shorter nightly sleep as the strongest adjusted predictor (aOR 0 . 649, 95% CI 0.450 to 0 .936, p = 0 .021) . Linear regression for lumbar severity confirmed body mass index as a positive predictor (β = 0 . 143, p = 0 .008) . Parallel analysis on the nine BDC scores supported a single general musculoskeletal-discomfort dimension. All 405 drivers exceeded the eight-hour daily duty limit set under the Motor Transport Workers Act, and 14.3% drove beyond twelve hours per day. The driver musculoskeletal burden documented here is roughly four times higher than published Indian general-population low back pain prevalence, providing biological corroboration for the 22 . 1% ergonomic share of heavy-duty vehicle collision causation reported earlier from Kerala.  \n1. Introduction  \nPublic road transport carries 54% of total passenger demand in India, with state-owned road transport corporations operating most of the long-distance and city bus services across the south of the country. The Kerala State Road Transport Corporation (KSRTC), one of the oldest such operators, employs more than fifteen thousand drivers across a fleet of around six thousand five hundred buses and serves approximately three million passengers each day. The health and safety of these drivers therefore translate directly into the safety of a large fraction of the travelling public. The driver, the cabin, and the road interact dynamically over a duty cycle that often exceeds ten hours in length, making the cab one of the most exposure-intensive workplaces in the formal sector.  \nEarlier work on Kerala road traffic accident causation, drawing on Kerala State Crime Records Bureau and police First Info","cbCaihzj1ZGz87aO","https://ap.wps.com/l/cbCaihzj1ZGz87aO","pdf",1657614,32,"English","# Introduction\n## Study Rationale\n## Objectives","[{\"question\":\"What population and sample size were analyzed in the study?\",\"answer\":\"The study analyzed 405 male bus drivers employed by the Kerala State Road Transport Corporation (KSRTC) across 14 districts in Kerala.\"},{\"question\":\"Which instruments were used to measure musculoskeletal disorders and sleepiness?\",\"answer\":\"Musculoskeletal disorders were assessed using the Standardised Nordic Musculoskeletal Questionnaire and Borg CR-10 based body discomfort chart, while daytime sleepiness was measured using the Epworth Sleepiness Scale.\"},{\"question\":\"What were the main findings regarding the most affected body regions and prevalence?\",\"answer\":\"The lumbar back recorded the highest 12-month prevalence (71.9%), with notable prevalences also reported for shoulders, neck, and knees, and many drivers reported disorders across multiple body regions.\"}]","Work-Related Musculoskeletal Disorders among Public Bus Drivers in Kerala - A Cross-Sectional Study Linking Ergonomic Strain to Road Safety Risk | PDF",81]