key: cord-0259619-y448dhvu
authors: Matsugaki, R.; Muramatsu, K.; Tateishi, S.; Nagata, T.; Tsuji, M.; Hino, A.; Ikegami, K.; Fujino, Y.; Matsuda, S.
title: Association between telecommuting environment and low back pain among Japanese telecommuting workers: A cross-sectional study
date: 2021-07-19
journal: nan
DOI: 10.1101/2021.07.15.21260610
sha: de0ec6b783b43d577d11dbc88cc5264778d029a3
doc_id: 259619
cord_uid: y448dhvu

Objectives: We evaluated the relationship between telecommuting environment and low back pain (LBP) among desk-based workers in Japan. Methods: This cross-sectional study included 3,663 desk-based, telecommuting workers. LBP was assessed using a 0 to 10 numerical rating scale. The telecommuting environment was evaluated using subjective questions. Mixed-effects logistic regression analysis was used. Results: Mixed-effects logistic model results revealed that not having a place or room to concentrate on work, desk not well-lit enough for work, not having enough space on the desk to work, not having enough legroom, and not having comfortable temperature and humidity conditions in the workspace were significantly associated with higher odds of LBP. Conclusions: Our findings suggest that telecommuting environment is associated with the prevalence of LBP.

. CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)

The coronavirus disease pandemic led to rapid expansion of 49 telecommuting in Japan. The Japanese government recommended telecommuting to 50 prevent the spread of COVID-19 infection 1,2 . Although the telecommuting rate of a 51

Japanese worker was 14.8% as of October 2019, it increased to 23.0% by November 52 2020 3 . In actuality, 85.0% of workers who were teleworking as of November 2020 did 53 so to prevent the spread of COVID-19 infection 3 . Telecommuting is a way to continue 54 business even in times of emergency, and it may become an even more common way of 55

With the rapid expansion of telecommuting due to the COVID-19 pandemic, 57 management of the work environment during telecommuting is an emerging 58 occupational health problem. As with the office environment, the recommended 59 working environment for a telecommute worker is a private, quiet, and safe dedicated 60 space, with adequate lighting, comfortable temperature and humidity, ergonomic 61 chairs/desk 4-6 . However, it is difficult to manage the telecommute work environment 62 because, in contrast to the office, the workstation at home is difficult to supervise by 63 managers, and managers do not have the authority to direct the private environment of 64 an individual. In addition, neither companies nor workers were sufficiently prepared to 65 optimize telecommuting environment due to the unexpected occurrence of COVID-19 4 . 66

It has been reported that more than 50% of telecommuting workers in Japan do not have 67 a desk/ chair and more than 70% do not have a private room or space for work 3 . 68

Low back pain (LBP) is an important health problem associated with office 69 work. The prevalence of LBP is 34-56% among office workers 7-10 . In office workers, 70 gender, body mass index, sleep disturbance, and previous symptoms of LBP are known 71 to be risk factors for LBP 8,10-13 . In terms of work-related factors, it is known that sitting 72 . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)

The copyright holder for this preprint this version posted July 19, 2021. ; https://doi.org/10.1101 https://doi.org/10. /2021 time and sitting posture at work are known to be risk factors for LBP in an office 73 worker 8, 14, 15 . At home, the work environment is less developed than in the office 74 environment; therefore, the work environment of home workers is assumed to be an 75 important risk factor for low back pain. 76

Previous studies conducted in the COVID-19 pandemic have suggested an 77 association between telecommuting and musculoskeletal pain 16 . However, the 78 relationship between work environment and LBP in telecommuting workers is unclear. 79

Thus, the purpose of this study was to clarify the relationship between the work 80 environment and LBP of telecommuting workers. 81 82 83

This cross-sectional internet-based monitoring survey was conducted from 86

December 22 through to December 26, 2020, when the third wave of COVID-19 87

infections began in Japan. The details of the survey protocol have been previously 88

reported. 17 The data was collected from the workers with employment contracts at the 89 time of the survey. Of the 33,302 workers participating in the survey, 27,036 were 90 surveyed, excluding those who gave fraudulent answers. Of these, 3,663 (2,093 males 91 and 1,570 females) who responded that they mainly performed desk work (e.g., office 92 work, computer work) and telecommuted at least once a week were included in the 93 present analysis. 94

This study conformed to the principles of the Declaration of Helsinki. In addition, 95 the study was approved by the ethics committee of the University of Occupational and 96 . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint this version posted July 19, 2021. ; https://doi.org/10.1101 https://doi.org/10. /2021 Environmental Health, Japan (reference No. R2-079). Informed consent was obtained 97 online from the participants through the website. 98

The assessment of LBP 100

We assessed the presence of LBP in the participants based on two questions. First, 101

we asked all subjects "Have you experienced stiff shoulders or LBP in the past two 102 weeks?" and asked them to answer, "yes" or "no." If the subject answered "yes" to that 103 question, the following questions were asked to assess the severity of LBP such as, "what 104 was your average level of LBP in the past 2 weeks? (Please rate your pain from 0 to 10, 105

where 0=no pain at all and 10=the most intense pain you have experienced)." The 106 numerical rating scale (NRS) was used for evaluating the pain severity. In this study, a 107 score of 3 or higher on the NRS was defined as LBP. 108

The assessment of the telecommuting environment 110

The telecommuting environment was assessed among the telecommuting workers 111 with the following questions: 1) "Do you have a place or room where you can concentrate 112 on your work?" ; 2) "Is your desk well-lit enough for you to work?" ; 3) "Do you have 113 enough space on your desk to work?"; 4) "Is there enough space to stretch the legs?"; 5) 114

"Are the degrees of temperature and humidity in the room where you work appropriate 115 for working comfortably?"; 6) "Do you use an office desk or chair? (Including children's 116 study desks)." The respondents answered either "yes" or "no." 117 118

The following items were examined for socioeconomic factors: age, sex, body 120 mass index (calculated by dividing the weight by height squared), educational 121 . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint this version posted July 19, 2021. ; https://doi.org/10.1101/2021.07.15.21260610 doi: medRxiv preprint background (junior high school; high school; vocational school; junior college or 122 technical college; university; or graduate school) and equivalent income (household 123 income divided by the square root of the household size). 124

The following items were examined for lifestyle factors: smoking (currently 125 smoking), drinking (alcohol consumption on two or more days per week), physical 126 activity (perform equivalent physical activities for at least 1 h a day in daily life for more 127 than 2 days a week), and exercise habit (exercise for 30 minutes or more for more than 128 two days a week). 129

For mental health status was assessed using the following question: "During the 130 past 30 days, how many days did you experience poor mental health, including stress, 131

depression, emotional problems, etc.?" 132

The following items were examined for work-related factors: we examined the 133 following items: industry type, working time (hours per week), frequency of 134 telecommuting (one day per week; more than two days per week; and more than four days 135 per week), company size (total number of employees at the company where the 136 respondent is working), and working hours per week. 137 138

The number of days that the participant experienced poor mental health during the 140 past 30 days are expressed as continuous variables using mean and standard deviation. 141

Other variables are presented as categorical variables using numbers and percentages. 142

Mixed-effects logistic regression analysis was conducted with the presence of 143 LBP as the dependent variable, subjective evaluation of the telecommuting environment 144 as the independent variable, with the city of residence as the random effects. We used age, 145 sex, body mass index, lifestyle habits, the number of days of poor mental health, 146 . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint this version posted July 19, 2021. The associations of LBP and telecommuting environments are shown in Table 2 . p=0.633). Similar results were obtained for Model 1, which was adjusted only for sex and 170 age, and Model 2, which was adjusted for other potential confounders. 171 . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint this version posted July 19, 2021. This study showed that telecommuting environment was associated with LBP 176 in telecommuting workers during the COVID-19pandemic. Specifically, it was 177 suggested that insufficient desk and foot space, inadequate desk lighting, uncomfortable 178 room temperature and humidity, and lack of room/space for concentrating on work were 179 associated with the prevalence of LBP. 180

In this study, inadequate desk and foot space, and insufficient lighting were 181 associated with LBP. It is suggested that an awkward posture and sitting for long The present study also revealed that uncomfortable temperature and humidity 189 in the telecommuting space was associated with LBP. Since this study was conducted 190 during the winter season, it can be speculated that the results imply that cold 191 temperature and low humidity is associated with LBP. The relationship between cold 192 temperature and LBP has been shown in previous studies 15, [21] [22] [23] ; this is also the same 193 for telecommuting workers. Although the most suitable room temperature for the 194 prevention of LBP is not clear, we consider that room temperatures that are subjectively 195 . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint this version posted July 19, 2021. ; https://doi.org/10.1101 https://doi.org/10. /2021 cold should be avoided as they may increase the risk of musculoskeletal symptoms and 196 injuries. 197 In this study, using an office chair/desk was not associated with LBP. This 198 finding is supported by the findings of previous studies reporting no significant 199 association between LBP and use of chair/desk in office workers 11, 24 . Alternately, 200 previous studies have reported that LBP is related to the characteristics of the chair, 201 such as with or without lumbar support and adjustable back support 8,18 . This may 202 suggest that it is not simply a matter of whether an office chair is used, but what 203 function and shape of the chair is used for prevention of LBP. 204

The lack of room or space to concentrate on work was associated with LBP. It 205 is suggested that the teleworker's workstation should be in a dedicated space that is 206 private, quiet, and secure, preferably away from the flow of activity in the home 4 . The 207

results of this study support that argument. Previous studies have reported that 208 psychological stress is associated with LBP in workers 25-27 . The lack of room or space 209 to concentrate on work may cause psychological stress to telecommuting workers. The 210 results of this study suggest that it is important for telecommuting workers to have a 211 space where they can devote themselves to their work as much as possible, even if they 212 work from home. 213

Based on these findings, we suggest that the work environment of 214 telecommuting workers may be associated with LBP. Therefore, employers need 215 educate telecommuting workers of the importance of an appropriate home working 216 environment. If it is difficult to prepare an appropriate telecommuting environment due 217 to household situations and family structure, it is necessary to consider the use of 218 co-working spaces, satellite offices, and spaces near the employee's residence for 219 telecommuting. 220 . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint this version posted July 19, 2021. ; https://doi.org/10.1101/2021.07.15.21260610 doi: medRxiv preprint previous history, duration of the symptoms, and diagnosis of LBP are unknown as only 222 the NRS was used for its evaluation. It is uncertain how these factors affect the 223 relationship between the telecommuting environment and low back pain. Secondly, the 224 home environment was also evaluated using subjective questions; hence, the validity of 225 the responses is unclear. However, an objective method to evaluate the work 226 environment at home has not been established at this time. Thirdly, there may be a 227 selection bias in this study. If it is possible to choose telecommuting, people with LBP 228 may be more likely to choose telecommuting. The effect of this bias on the results of 229 this study is uncertain. 230 231

The present study suggests that telecommuting environment is associated with 233 the prevalence of LBP among telecommuting workers in Japan and suggests that 234 employers may need to consider providing telecommuting workers with a working 235 space where they can concentrate on their work with appropriate room temperature and 236 humidity control to prevent LBP. 237 . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint this version posted July 19, 2021. ; https://doi.org/10.1101 https://doi.org/10. /2021 . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint this version posted July 19, 2021. SD: standard deviation . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)

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by the Headquarters for Novel Coronavirus Disease Control. Basic 239 Policies for Novel Coronavirus Disease Control. Ministry of Health

2. Decisions by the Headquarters for Novel Coronavirus Disease Control

Policies for Novel Coronavirus Disease Control (Revised on

Ministry of Health, Labour and Welfare

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The copyright holder for this preprint this version posted July 19, 2021. ; https://doi.org/10.1101 https://doi.org/10. /2021 CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)The copyright holder for this preprint this version posted July 19, 2021. ; https://doi.org/10.1101 https://doi.org/10. /2021