key: cord-0724553-fvfgpr30
authors: Radulović, Azra Huršidić; Žaja, Roko; Milošević, Milan; Radulović, Bojana; Luketić, Ivica; Božić, Tajana
title: Work from Home and Musculoskeletal Pain in Telecommunications Workers During COVID-19 Pandemic: a Pilot Study
date: 2021-09-28
journal: Arh Hig Rada Toksikol
DOI: 10.2478/aiht-2021-72-3559
sha: 40d256cce7160ee6a3d55c9765d86881b8c9c87c
doc_id: 724553
cord_uid: fvfgpr30

One of the side-effects of the COVID-19 pandemic is a global change in work ergonomic patterns as millions of people replaced their usual work environment with home to limit the spread of the severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) infection. The aim of our cross-sectional pilot study was to identify musculoskeletal pain that may have resulted from this change and included 232 telecommunications company workers of both genders [121 (52.2 %) men aged 23–62 (median 41; interquartile range 33–46 yrs.) and 111 (47.8 %) women aged 23–53 (median 40; interquartile range 33–44)] who had been working from home for eight months (from 16 March to 4 December 2020) before they joined the study. The participants were asked to fill in our web-based questionnaire by self-assessing their experience of hand, lower back, and upper back/neck pain while working at home and by describing their work setting and physical activity. Compared to previous work at the office, 90 (39.1 %) participants reported stronger pain in the lower back, 105 (45.7 %) in the upper back/neck, and 63 (27.2 %) in their hands. Only one third did not report any musculoskeletal problems related to work from home. Significantly fewer men than women reported hand, lower back, and upper back/ neck pain (p=0.033, p=0.001 and p=0.013, respectively). Sixty-nine workers (29.9 %) reported to work in a separate room, 75 (32.4 %) worked in a separate section of a room with other household members, whereas 87 (37.7 %) had no separate work space, 30 of whom most often worked in the dining room. Ninety-five participants (40.9 %) had no office desk to work at, and only 75 (32.3 %) used an ergonomic chair. Of those who shared their household with others (N=164), 116 (70.7 %) complained about constant or occasional disturbances. Over a half of all participants (52 %) said that they worked longer hours from home than at work, predominantly women (p=0.05). Only 69 participants (29.9 %) were taking frequent breaks, predominantly older ones (p=0.006). Our findings clearly point to a need to inform home workers how to make more ergonomic use of non-ergonomic equipment, use breaks, and exercise and to inform employers how to better organise working hours to meet the needs of work from home.

The COVID-19 epidemic has changed our lives and our working habits. From its start, workers were referred to working from home to limit the spread of infection with the severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) (1). This change in working environment has, in turn, brought major changes in work ergonomics and added to the current challenges to health at work, most notably in terms of preventing/minimising musculoskeletal pain. According to the European Agency for Safety and Health at Work (EU-OSHA), work-related musculoskeletal disorders (MSDs) are still among the most common work-related health issues in Europe (2) . Physical risk factors for their development include repetitive movements and awkward postures. To minimise the risks at the workplace, employers are required to meet minimum safety and health standards for work with computers in accordance to Croatian and EU regulations (3, 4) . Accordingly, EU-OSHA has recommended that employers should allow and help their workers use their office equipment for work at home (5) .

Lockdowns have also brought new challenges to occupational health and safety at work specialists in addressing the issues resulting from the "new normal". But to address them with appropriate guidelines and measures, they first need to get to know what these specific issues are, especially in our country in which such information is still scarce. This is why we have developed a questionnaire intended for those who work from home. The aims of our pilot study were the following: 1) to see whether telecommunications company workers had more severe musculoskeletal pain than before they started working from home, 2) to establish whether the pain was related to work conditions at home, and 3) to recommend preventive measures on the national level.

This cross-sectional pilot study included 232 telecommunications company workers of both genders [121 (52.2 %) men aged between 23 and 62 (median 41; interquartile range 33-46 yrs.) and 111 (47.8 %) women aged between 23 and 53 (median 40; interquartile range 33-44)] who had been working from home for eight months (from 16 March to 4 December 2020) before they joined the study.

The questionnaire "Work from home and musculoskeletal pain in COVID-19 pandemic" was designed by the authors of this study as a web-based, self-reporting survey intended to evaluate working conditions, physical activity, and hand, lower back, and upper back/neck pain experienced by responders who work at home. We used it in this study for the first time and distributed the link to the workers by email through their company's Safety at Work Unit.

Some dimensions or sections in the questionnaire are there to establish facts (as opposed to subjective assessment), and the questions reflect that intention. With some factestablishing questions the choice of one answer over another starts a new set of questions to minimise respondent's interpretation error or skipping the question (missing values). All answers were saved automatically over the web to avoid input errors (either by respondents or investigators).

The introductory part of the questionnaire informs the participants about the aims of research. Follow five sections totalling 50 questions (items), depending on the answer chosen in the previous questions. First the responders answer questions about their age and gender. The second section seeks to establish the characteristics of their workspace, whether it is shared with other household members (if any) or separated and how. The third section looks into the ergonomic properties of their work space related to furniture and equipment (office desk, adjustable office chair, monitor, desktop, laptop, and mouse), employers help in supplying them, and responders' perception of air quality, noise, and lighting. The fourth section of the questionnaire looks into the organisation of work at home [whether the household members (if any) disturb workers at work, how often they take breaks, how they schedule tasks, and how long their working hours are], exercising patterns (whether and how often they exercise over the working week, does this happen during breaks, is it organised in groups, does it take place in a gym or at home), and musculoskeletal pain (hands, lower back, upper back and neck). The fifth section looks into responders' perception of their own mood while they work, whether they keep informal contacts with colleagues, whether they are pleased with their diet, how they manage to separate work from private life, and whether they would continue to work from home, given the option.

The questions about the age, frequency of exercising over the week, and the number of household members (where applicable) are requiring numeric answer. There are two questions asking participants to describe their mood and why they cannot separate work from private life (where applicable), while the rest are multiple-choice questions.

At the end, responders are asked to acknowledge their informed consent to participate in the study by selecting the statement of voluntary and anonymous participation.

Responses were evaluated qualitatively for content validity [focusing on construct validity, clarity of instructions, linguistic aspects of the items, representativeness of the item pool, and adequacy of response format (6, 7)] by five occupational health / work safety experts using the consensus method (6) .

Dimensions (whether those establishing facts or requiring subjective assessment) were validated with the standard internal consistency test, i.e. Cronbach's alpha (CA), which establishes scale reliability when the dimensions consist of multiple variables (questions, items) (see Table 1 for the dimension Disturbances). Basically, CA is null (0) when the content does not correlate entirely. Correlation is excellent when CA is 1.

Dimensions consisting of two or three fact-establishing and subjective assessment variables (questions) were correlated with Spearman's correlation (e.g. "satisfaction" significantly correlated with the question "How does it feel to work at home?" and "Can you separate time for work from time for private life").

Dimensions addressing subjective assessment of health issues were constructed in accordance with standard clinical health-related questions routinely asked of patients by occupational health specialists. Questions about a specific Huršidić Radulović A, et al. Work from home and musculoskeletal pain in telecommunications workers during COVID-19 pandemic Arh Hig Rada Toksikol 2021;72:232-239 Sixty-eight workers lived alone, and among those who shared their household with others (N=164), 116 (70.7 %) reported being disturbed at work from home (Table 4) .

Over a half (52.2 %) of all participants estimated that they worked longer hours than in the office, significantly more women than men ( Figure 4 ).

In comparison with earlier work at the office, 69 (29.9 %) of all participants reported taking breaks more often when they worked from home, men significantly more than women (P=0.003; Figure 5 ).

Only 33 (14.2 %) reported exercising during breaks, of whom 29 worked on the lower back, 25 on the neck, and 15 on hands.

Eighty participants (34.5 %) who exercised regularly regardless of the breaks mostly reported exercising three times a week. Of the remaining 152 (65.5 %) who did not exercise regularly, 70 reported that they could not bring themselves to start exercising, 30 complained of lack of space, and 38 of lack of time to exercise. Those who did not exercise also had a significantly higher incidence of lower back (P=0.021) and upper back/neck pain (P=0.024) than those who exercised regularly.

Complaints of more severe work-related musculoskeletal pain at home than in the office turned out to correlate (Spearman's ρ) with not having ergonomic chair at home or an office desk and with disturbance by other household members, longer working hours at home, women and no (regular) exercise (Table 6) .

phenomenon or our questions about pain aimed to discover whether the phenomenon was stronger (+), the same (=), weaker (-), or there was none (0) are important and independent, and their grouping is not clinically justified.

For data analysis we used descriptive statistics. Depending on the data distribution, we used appropriate non-parametric tests as follows: the chi-squared test for categorical values, Kruskal-Wallis test for continuous data, and Spearman's rank correlation for variables and reports of stronger musculoskeletal pain. P values below 0.05 were considered statistically significant. All results were run on SPSS for Windows, version 25 (SPSS Inc., Chicago, IL, USA).

Even though one woman chose not to give her age, we can safely say that the median age did significantly differ between the genders. Two participants skipped the questions on lower back and upper back/neck pain, and one participant skipped the answer specifying work space. Significantly fewer women than men reported no pain in any analysed body part (Figures 1-3) .

Of the 231 participants who specified their work space at home, 69 (29.9 %) reported to work in a separate room, 75 (32.4 %) in a separate section of shared space, and 87 (37.7 %) in a shared space with other tenants ( Among the participants who reported stronger musculoskeletal pain than in the office, women exercised less often over breaks than men (P=0.021 for lower and upper back/neck pain and P=0.035 for hand pain), and more of them had no separate work space (P=0.007).

Further analysis showed a significant correlation between age and stronger hand pain at home (0.134; P=0.042) or taking breaks more often at home than at the office (-0.174; P=0.008). Older participants also reported working longer hours at home than at the office, but we found no significant age difference between them and the group reporting not to work longer hours.

Regardless of the above results showing deterioration in musculoskeletal pain associated with working from home, 71.6 % participants said that they would like to continue working from home once the pandemic is over.

The prevalence of musculoskeletal pain is significant in people working with computers (8) . This prevalence is also influenced by gender, especially the neck pain, which is more prevalent in women (9) . De Kok et al. (2) reported 42 % and 45 % prevalence of lower back pain and 39 % and 44 % prevalence of neck pain in men and women working with computers at the office, respectively. The prevalence of stronger pain in the lower back, upper back/ neck, and hands (39.1 %, 45.7 %, and 27.2 %, respectively) reported by our participants for work from home as opposed to work at the office (Table 2 ) exceeds reports published in similar studies. One study from Turkey (10), carried out during a lockdown, also reported significant worsening of lower back pain in people who worked from home in comparison with those who continued to work at their regular workplaces, but it was much lower (about 4 %) than in our study (39.1 %). However, unlike the participants who worked from home in the Turkish study (teachers, academics, and students), our participants work for a telecommunications company, and their jobs involve work on computers all the time, which is why we believe our prevalence of lower back pain worsening is much higher. Similar to our findings, another study in Italy (11) reported worsening of neck pain in 50 % of participants.

Our findings also point to significantly higher prevalence of worsened musculoskeletal pain in women than men (Figures 1-3) . Similar was observed among female office workstation users who were working from home during the COVID-19 pandemic and had more physical and mental issues (12) .

Only 29.7 % of our participants reported to have worked in a separate room at home, and as many as 37.9 % did not even have a separate working space but worked in the kitchen or the dining room (Table 3 ). For comparison, Bloom (13) reported that nearly half of his participants had a separate work room (a studio or office room, not a bedroom) to work in.

The working conditions at the telecom company that employs our participants completely meet the requirements of the 1990 Council Directive 90/270/EEC on the minimum safety and health requirements for work with display screen equipment, which includes ergonomic requirements (4) . This raises concern about our finding that at home 40.9 % of workers from this company did not have an office desk to work at but had to make do with the kitchen, dining, and other makeshift tables. Another cause for concern is that 67.7 % of our participants did not use an ergonomic chair (Table 4) , even though the employer offered this option to those who did not have their own ergonomic chair, but only 10 participants took it. The reason that many participants gave for not taking this option was the lack of space at home. The employer also followed the EU-OSHA recommendations and supplied laptops, monitors, and ergonomic mice to those who wanted to work with them.

Our findings raise concern about how few participants realised the importance of ergonomically designed workplace and equipment, as our analysis showed a significant association between worsened hand pain and lack of office desk at home, confirming the findings published by Alyami et al. (14) .

As various recommendations go, taking frequent breaks from working with a computer is highly recommended (3, 15) , as well as practicing exercises intended to ease the load on the spine, neck, upper extremities, and the eyes (16) . In our study, significantly more men were taking more breaks from work at home than women ( Figure 5 ), but only a small minority used them for physical exercise. Our findings also suggest that women work longer hours at home, take breaks less often, and get disturbed more often than men, which may reflect household distribution of work based on the traditional gender roles, but this will require more investigation.

In terms of physical exercise as a way to prevent or minimise musculoskeletal pain (17) , only 34.5 % of our participants reported exercising regularly, most often three times a week. Of the remaining participants, one third admitted to "having trouble getting started". Our study has found a correlation between not exercising regularly and stronger lower or upper back/neck pain. It has also highlighted the issue that women prevail in this correlation: they reported having stronger pain, exercising less, and taking fewer breaks than men. In other words, women seem to take less care to prevent or minimise their musculoskeletal pain.

Older participants, in turn, reported taking breaks more often, most likely to alleviate musculoskeletal pain, which they reported more often, hand pain in particular. In Arh Hig Rada Toksikol 2021;72:232-239 accordance with the need to take breaks regardless of the age, one earlier study showed the strongest association between working more than two hours without taking a break and neck complaints (18) .

At home, most workers face a great challenge of how to organise their work without disturbances. In our study, 164 (70.7 %) of the participants shared their household with other members. Of them, 116 (70.7 %) reported being disturbed by their household members all the time or occasionally (Table 5 ). This may also be the reason why over a half of all our participants worked longer hours at home than at the office, women in particular (Figure 4 ). One earlier Croatian study (19) reported that even in the office women worked longer hours on a computer than men, which suggests that work from home had only exasperated the problem.

We believe that the increase in musculoskeletal pain at home in our study is partly owed to disturbances by household members and longer hours. Longer hours have already been recognised as a risk factor for teleworking (20) , and the musculoskeletal pain is known to be associated with anxiety, poor sleep, and general fatigue (2) . However, the association with psychosocial issues is less clear, as most of research is focused on biomechanical effects on soft tissues and tolerance thereof (21) . One of the rare studies that did look into psychosocial issues has pointed to the association between musculoskeletal pain and job tenure of correction officers as those specifically exposed to psychosocial stressors (22) .

As expected, our findings suggest that poorer working conditions at home (work space and ergonomic considerations) present a risk for the development of musculoskeletal pain, as nearly 40 % of our participants experienced stronger work-related pain. In fact, they confirm Schott's summary of the big Lenovo-sponsored study that "Working From Home is a Literal Pain in the Neck" (23) . But our study has also confirmed that the development of musculoskeletal pain has other causes than poor ergonomic design of the workplace and includes gender, age, organisation, disturbance by household members, and longer hours.

Even so, most of our participants (71.6 %) expressed a wish to continue working from home and seem to have accepted it as a new workplace. Considering, however, that this new workplace entails new health and safety risks, especially those related to the development and/or worsening of musculoskeletal pain, we believe that new safety recommendations and preventive measures are required and that the approach to the issue should be multidisciplinary and integrated to improve workers' condition and minimise work-related pain (24) . We have therefore come up with a few suggestions in this respect. As the employer cannot completely control the design and ergonomic properties of the workplace at home over legal considerations related to private property and privacy, it can only offer to inspect the new workplace and provide ergonomic desk and chair, but, more importantly, it can teach the workers how to improve their "imperfect" working conditions and make them ergonomically acceptable.

This kind of education should also highlight the importance of frequent breaks and promote brief exercises for workers, preferably organised for groups and coached online while social distancing requirements still apply.

Even though the employer cannot do much about disturbance by other household members, it can insist that workers do not work longer than they would at the office, which includes time spent on communication by phone or email.

Our questionnaire has proved itself to be a welcome instrument for collecting relevant information to assess working conditions at home. Considering that this study with participants from a telecommunication company has been our first, trial run, there is plenty of room for improvement, but, generally, we can conclude that the working conditions at home can be satisfactory, provided that the above preventive measures are in place. Further research should address gaps to be filled to get a complete picture of our findings and improve occupational safety and health assessment of work at home.

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