Back pain in a group of computer workers assessed in a physiotherapy unit

Abstract

BACKGROUND:

Modern society work implies computer-based activities generating back pain because of prolonged sitting positions and non-ergonomic postures.

OBJECTIVE:

The aim of the study was to analyse the back-pain characteristics in a group of office workers in comparison with potential risk factors.

METHODS:

The design of the study was retrospective; a group of 109 computer workers with back pain was selected from a private physiotherapy unit between Jan 2018 - Dec 2019. Anthropometric, occupational and behaviour data, symptoms, the diagnosis on the first visit, previous medical diagnosis and specific physical activities were collected from medical records.

RESULTS:

The studied group (research sample) is formed of information technology operators, engineers and economists, had the mean age 38.91±10.25, with 14.04±9.12 years seniority at work. Most of them addressed to the physiotherapist directly, or they were referred by their family physician; 60% had MRI investigation on the first physiotherapy visit with no medical referral or diagnosis. The symptoms were not reported to the occupational physician. The back pain appeared independent of BMI; the low back pain had higher prevalence in males. Patients reported 6 months of back pain in 57,8% of all cases. The pain was favoured by continuous activity, more than 4 hours, in the sitting posture.

CONCLUSIONS:

A complex and interdisciplinary team that included an occupational physician, an ergonomist and a physiotherapist could prevent and control back pain in computer workers. Workplace conditions adaptation, proper physiotherapy and periodical medical check-ups could improve the health status of these workers.

Keywords

Back pain computer working physiotherapy ergonomics occupational health

Iulia Iovanca DRĂGOI is PhD student at “Victor Babes” University of Medicine and Pharmacy Timisoara, Romania Division of Vascular Surgery and Reconstructive Microsurgery, co-assisted by Manchester University in UK. She has graduated a Master programme at Politehnica University of Timisoara, Romania in the field of Implants, Prostheses and Biomechanical Evaluation and Rehabilitation of Musculoskeletal Disorders. She is physiotherapist, member of Director Council of Romanian Podiatry Association with a special interest in education for diabetic foot and amputation reduction strategies.

Florina Georgeta POPESCU is MD, PhD, Occupational Health Senior specialist, lecturer at at “Victor Babes” University of Medicine and Pharmacy Timisoara, Romania and coordinator of the Occupational Medicine Clinic in the Emergency Municipal Hospital Timisoara, Romania. She is coordinator of resident doctors in Occupational Medicine, member in international organization as: ICOH and EASOM. She was involved in different international projects and her fields of interest are ergonomics, occupational diseases, especially pneumoconiosis.

Pompilia Camelia LĂZUREANU is MD Internal Medicine Specialist, PHD student and researcher at “Lucian Blaga” University of Sibiu, Romania. She is university assistant in the Department of Physiology of the above mention university. Her fields of interest in research are chronic inflammation and autoinflammatory diseases.

Ramona ANCULIA is PhD Student at University of Medicine and Pharmacy “Victor Babes” Timisoara, Romania. She is a Public Health and Management specialist and Occupational Medicine Resident at the Emergency Clinical Municipal Hospital Timisoara, Romania.

Melania GHIGULESCU is Occupational Medicine Resident at the Emergency Clinical Municipal Hospital of Timisoara, Romania. She has experience as inspector in Health and Safety of Work processes.

Ioana MARIN is MD, Occupational Medicine Specialist and PhD student at “Victor Babes” University of Medicine and Pharmacy Timisoara, Romania. She graduates a Master programme in Management of Health Units at the University of Medicine and Pharmacy Craiova, Romania. She is member of the Romanian Society of Occupational Medicine, having previous experience in pharmaceutical field and medical devices at Boston Scientific Corporation.

Elena-Ana PĂUNCU is Occupational Physician, full professor at “Victor Babes” University of Medicine and Pharmacy Timisoara, Romania, being president of Occupational Medicine section of the Romanian College of Occupational Physicians and UEMS representative, ICOH and EASOM member, vice-president of the Romanian Society of Occupational Medicine and of the Occupational Health Commission of the Romanian Health Ministry. She was responsible of various projects in the field of occupational medicine and her professional expertise is related to stress management, ergonomics, pneumoconiosis, occupational pathology, teaching/ training.

1 Background

The occupations involving sedentary tasks, such as office computer work, have been associated with musculoskeletal disorders (MSD). Pain, muscle tension, functional limitation, stiffness, reduced range of motion are often located in the spine area, shoulder, upper and lower limbs, pain being the most reported symptom. Low back and neck pain are highly prevalent musculoskeletal disorders in the general working population, associated with disability in high-income countries [1, 2]. The multifactorial etiology of MSD is a possible result of biomechanical risk factors, individual factors and psychosocial factors or a combination of all these [3, 4]. In computer workers, prolonged sitting position, non-ergonomic postures, and repetitive movements are recognized as biomechanical risk factors that could generate musculoskeletal pain. Age, gender, body mass index (BMI), medical history, body posture type could be intrinsic contributing factors for MSD [3, 5]. Psychosocial factors at work could represent aggravating as well as contributing factors for musculoskeletal symptoms. Cognitive requirements and specific activity demands, the number of hours of computer work as well as environment facilities may determine stress level in computer workers [3 , 7].

The symptoms localized in the lumbar spine are common complaints in prolonged sitting computer workers [8], having a higher prevalence compared with cervical and thoracic spine. Chronic low back pain and non-specific low back pain have been extensively studied in the medical literature [9, 10].

Physical therapy gained an important role in MSD recognition, assessment, and treatment, being a safe and cost-effective medical approach for many types of back pain [11].

According to the Romanian Occupational Health and Safety (OHS) legislation, computer workers, as any employee, benefit annually from a complex health assessment made in accordance with the workplace risk factors, evaluation performed by the occupational health physician [12, 13]. Employees are recommended to report all musculoskeletal symptoms and any physical complaints or acute injuries to the company occupational medical team [12, 14].

Many countries involve ergonomists to evaluate and ensure safety and health of the workers, adapting working conditions at their workplaces. The procedures of official recognition of the ergonomist profession were initiated and approved in Romania in 2018 [15].

A multidisciplinary team that includes an occupational physician, a physiotherapist and an ergonomist could prevent work-related MSD by identifying early musculoskeletal signs, by performing preventive and ergonomic interventions and by applying curative physical therapy.

The aim of the study was to analyse the back-pain characteristics in a group of office workers in comparison with potential risk factors from the perspective of the physiotherapist. The novelty of the study was to emphasize the lack of consensus when collecting ergonomic data that may constitute potential work-related risk factors for back pain in computer workers.

2 Methods

2.1 Description of the research methodology

This retrospective study analysed the recorded medical files of 109 office workers with prolonged sitting posture that accused back pain and who were assessed in a private physiotherapy unit in Timisoara, between Jan 2018 – Dec 2019. The ethical principles (respecting patient’s rights and the confidentiality of the personal data) were achieved in accordance with the existing medical legislation.

The eligibility criteria for file selection were adult, active worker with more than 40 hours of computer use per week, presenting back pain. The exclusion criteria for file selection were: PC workers with registered comorbidities such as: rheumatic diseases, active or history of tumours, active infections, recent trauma or past spinal surgical interventions. The files of pregnant female patients registered were excluded from the study.

The anthropometric data (height, weight, BMI), occupational aspects (profession, seniority in work, self-reported activity, position at work, working time and breaks), behaviour data (smoking, alcohol consumption, diet, medication), symptoms (location, time and type of symptoms at the onset, characteristics of pain, neurological signs, provocative factors), previous medical diagnosis, diagnosis after the assessment, personal medical history and specific physical activities were collected from the medical records and were analysed. Sport activities and active hobbies were registered as well. The diagnosis criteria of back pain were based on the registered symptoms of the patients, on the previous clinical examination results and the imagistic investigations. The back-pain localization was registered as the patient self-indicated the spinal area on the body chart. Thus, three groups were identified based on the localization of back pain on the body chart: low back pain, thoracic pain, and cervical pain. The cervical, thoracic, or lumbar areas were patient self-indicated as painful with either unilateral, bilateral, or central localization. Based on the time from the onset, the symptoms were classified as <1 month, 1–6 months, 6–12 months, 1–3 years and >3 years. Acute or progressive onset of symptoms were accepted. Paraesthesia, numbness, dysesthesia, hyperesthesia, hypoesthesia, allodynia were registered as sensitive neurological signs. The presence of fasciculation and paresis were mentioned as motor neurological disturbances. Mechanical, continuous/ discontinuous, irradiating or referred type of pain were also mentioned. Common provocative factors such as PC work, orthostatic posture, sport or personal hygiene were considered as well. Kyphotic, flat back/sway back and hyperlordosis were assessed in orthostatic position. The posture types analysed in the sitting position were also registered. The pain intensity was quantified by using an 11 points Visual Analog Scale (VAS).

2.2 Statistical analysis

According to the location of the back pain, three subgroups were analysed: lumbar pain (LP), thoracic pain (TP) and cervical pain (CP). The patients who accused more than one location of back pain were distributed into several subgroups. When comparisons were made, we compared each subgroup against the other patients without that characteristic.

The statistical analysis was performed by using the SPSS version 19. For numeric variables we used arithmetic means and standard deviations (SD). To compare the mean values of the study subgroups the Independent T Test was applied. For nominal variables we used the number and the frequency (%) as descriptive statistics and Chi-square test/Fisher exact test for comparing the two frequencies. For the variables with more than two categories we compared each category against all the others taken as a single subgroup. The magnitude of the association was expressed in odds ratios (ORs) and their 95% confidence interval (CI). In these analyses the significance level was p < 0.05.

3 Results

3.1 Characteristics of the studied group

Table 1 shows the characteristics of the group of study.

Table 1
Characteristics of the group of study

Demographic data Group (N = 109)

Age (mean±SD) 38.91±10.25

Seniority at work (mean±SD) 14.04±9.12

Male, no. (%) 61 (56)

Weight status, no. (%)

•Underweight 5 (3.7)

•Normal 55 (50.5)

•Overweight 38 (34.9)

•Obese 12 (11)

Occupation, no. (%)

•Economist 24 (22)

•Engineer 32 (29.4)

•IT operator 43 (39.4)

•Other 10 (9.2)

Self-reported type of activity, no. (%)

•Sedentary 47 (43.1)

•Active 11 (10.1)

•Mixt 51 (46.8)

Number of working hours/day (mean±SD) 7.98±1.02

Referred by, no. (%)

•Doctors 49 (45)

•Self-referred 60 (55)

Smoking, no. (%) 18 (16.5)

Alcohol, no. (%) 0 (0)

History of trauma, no. (%) 35 (32.1)

History of similar back problems, no. (%) 43 (39.4)

History of surgery, no. (%) 48 (44)

Cardiovascular comorbidities, no. (%) 19 (17.4)

Metabolic diseases, no. (%) 10 (9.2)

Allergy, no. (%) 14 (12.8)

Gastrointestinal diseases, no. (%) 13 (11.9)

Characteristic of symptoms and patient evaluation

Cervical pain, no. (%) 20 (18.3)

Thoracic pain, no. (%) 19 (17.4)

Lumbar pain, no. (%) 77 (70.6)

Time from onset of symptoms no. (%)

•Less than 1 month 28 (25.7)

•1–6 months 37 (33.9)

•6 months–1 year 15 (13.8)

•1–3 years 20 (18.3)

•More than 3 years 9 (8.3)

Onset of symptoms, no. (%)

•Acute 45 (41.3)

•Progressively 64 (58.7)

Localization of pain, no. (%)

•Unilateral 34 (31.2)

•Bilateral 8 (7.3)

•Central 65 (59.6)

•No data 2 (1.8)

Sensitive neurological symptoms, no. (%) 54 (49.5)

Motor neurological symptoms, no. (%) 11 (10.09)

Mechanic type of pain, no. (%) 92 (84.4)

Continuous type of pain, no. (%) 20 (18.3)

Irradiation type of pain, no. (%) 38 (34.9)

Provocative factor - PC work, no. (%) 51 (46.8)

Provocative factor - orthostatic posture, no. (%) 51 (46.8)

Provocative factor - sport, no. (%) 25 (22.9)

Provocative factor - personal hygiene, no. (%) 11 (10.1)

Posture type, no. (%)

•Kyphotic 17 (15.6)

•Flat back/sway back 17 (15.6)

•Hyperlordosis 63 (57.8)

•No data 11 (10)

Pain intensity (VAS) (mean±SD) 5.58±0.34

Imaging investigations – MRI, no. (%)^* 63 (57.8)

Imaging investigations – CT, no. (%)^* 6 (5.5)

Imaging investigations - X-ray, no. (%)^* 25 (22.9)

Demographic data	Group (N = 109)
Age (mean±SD)	38.91±10.25
Seniority at work (mean±SD)	14.04±9.12
Male, no. (%)	61 (56)
Weight status, no. (%)
•Underweight	5 (3.7)
•Normal	55 (50.5)
•Overweight	38 (34.9)
•Obese	12 (11)
Occupation, no. (%)
•Economist	24 (22)
•Engineer	32 (29.4)
•IT operator	43 (39.4)
•Other	10 (9.2)
Self-reported type of activity, no. (%)
•Sedentary	47 (43.1)
•Active	11 (10.1)
•Mixt	51 (46.8)
Number of working hours/day (mean±SD)	7.98±1.02
Referred by, no. (%)
•Doctors	49 (45)
•Self-referred	60 (55)
Smoking, no. (%)	18 (16.5)
Alcohol, no. (%)	0 (0)
History of trauma, no. (%)	35 (32.1)
History of similar back problems, no. (%)	43 (39.4)
History of surgery, no. (%)	48 (44)
Cardiovascular comorbidities, no. (%)	19 (17.4)
Metabolic diseases, no. (%)	10 (9.2)
Allergy, no. (%)	14 (12.8)
Gastrointestinal diseases, no. (%)	13 (11.9)
Characteristic of symptoms and patient evaluation
Cervical pain, no. (%)	20 (18.3)
Thoracic pain, no. (%)	19 (17.4)
Lumbar pain, no. (%)	77 (70.6)
Time from onset of symptoms no. (%)
•Less than 1 month	28 (25.7)
•1–6 months	37 (33.9)
•6 months–1 year	15 (13.8)
•1–3 years	20 (18.3)
•More than 3 years	9 (8.3)
Onset of symptoms, no. (%)
•Acute	45 (41.3)
•Progressively	64 (58.7)
Localization of pain, no. (%)
•Unilateral	34 (31.2)
•Bilateral	8 (7.3)
•Central	65 (59.6)
•No data	2 (1.8)
Sensitive neurological symptoms, no. (%)	54 (49.5)
Motor neurological symptoms, no. (%)	11 (10.09)
Mechanic type of pain, no. (%)	92 (84.4)
Continuous type of pain, no. (%)	20 (18.3)
Irradiation type of pain, no. (%)	38 (34.9)
Provocative factor - PC work, no. (%)	51 (46.8)
Provocative factor - orthostatic posture, no. (%)	51 (46.8)
Provocative factor - sport, no. (%)	25 (22.9)
Provocative factor - personal hygiene, no. (%)	11 (10.1)
Posture type, no. (%)
•Kyphotic	17 (15.6)
•Flat back/sway back	17 (15.6)
•Hyperlordosis	63 (57.8)
•No data	11 (10)
Pain intensity (VAS) (mean±SD)	5.58±0.34
Imaging investigations – MRI, no. (%)^*	63 (57.8)
Imaging investigations – CT, no. (%)^*	6 (5.5)
Imaging investigations - X-ray, no. (%)^*	25 (22.9)

N - number of responding patients included in the study, for each item; mean±SD - mean and standard deviations; % - percentage of patient; VAS-Visual Analog Scale; PC – personal computers; IT- information technology; MRI – Magnetic Resonance Imaging; CT-Computed Tomography, X-ray – Radiography; ^*Data available only for 94 patients.

The mean age was 38.91 (SD = 10.26) with 20 subjects aged <30, 47 subjects aged ≥30 < 40, 22 subjects aged ≥40 < 50, 13 subjects aged ≥50 < 60 and 7 subjects ≥60 < 64. The seniority at work was 14.04±9.12 years, and there was a small difference in gender (56% males vs 44% females). Operators and engineers working in the field of information technology (IT) programming represented the highest population in this study group (68.8%), 22% personal computer (PC) users worked as economists, and 9.2% were involved in other occupations (lawyer, translator, secretary). Only 10.1% of patients declared an active physical life, compared with the similar rate of sedentary subjects (43.1%) and mixed activity subjects (46.8%). The posture at work was the sitting position in most cases (89%).

From the total number of subjects, 45.9% had a BMI more than 25 kg/m² with 11% obese (BMI≥30 kg/m²). The patients seeking physiotherapy intervention were self-referred in 55% of the cases and sent for rehabilitation following a physician evaluation in 45.4% of cases. No case was referred by the occupational health physician as patients did not report their symptoms at the onset or during their periodical check-up evaluation. Smokers represented 16.5% of the patients and chronic alcohol consumption was denied. Musculoskeletal trauma antecedents appeared in 32.1% of all the cases with most of them being sport related. Surgical history of any type was present in 44%, and 39.4% reported past similar musculoskeletal symptoms. Cardio-vascular diseases were present in 17.4%, allergies in 12.8%, gastrointestinal in 11.9% and metabolic conditions in 9.2%.

3.2 Characteristics of symptoms and patient evaluation

Pain and neurological complaints were collected as primary symptoms. Low back pain had a higher rate (70.6%) when compared with thoracic (17.4%) and cervical pain (18.3%), with higher prevalence in males (57.1%). From the total number of cases, 12 subjects (11%) experienced thoracic and lumbar pain and only one subject experienced pain on all spine levels. Other musculoskeletal complaints were present in 9.2% of cases in the knees area and 6.4% in the shoulders area. Patients reported more than 6 months of back pain in 40.4% of all cases. Chronic low back pain was present in 48.1% from the total number of patients experiencing low back symptoms. Participants in the 30–40 decade had a higher rate of acute and chronic low back pain when compared with all other decades, with a higher incidence in males (data not shown). The onset of the symptoms in the study group installed mainly progressively for more than half of the subjects (58.7%). In the low back pain group 64.9% of the subjects developed symptoms progressively. The location of spinal pain was central for 59.6%, unilateral for 31.2% and bilateral for 7.3%. The neurological type of symptoms was highly sensitive in 49.5% when compared with the motor signs, reported in 10.1% of the cases. The sensitive neurological complaints related to all spine levels were paraesthesia in 39.5%, numbness in 6.4%, hyperesthesia in 1.8%, hypoesthesia in 17.4%, dysesthesia in 18.4% and allodynia in 2.8%. The motor neurological complaints were fasciculations in 8.2% with self-reported motor deficit in 0.9% and allodynia with clinically tested paresis in 2.8%. Most of the subjects declared mechanical (84.4%) and discontinuous (71.6%) type of pain. Provocative factors for back pain ware mainly represented, in an equal proportion, by PC work and orthostatic posture. Sport activities triggered symptoms in 22.9% of the patients and only 10.1% felt pain during personal hygiene activities. Tables 2 and 3 present the association factors and the location of back pain.

Table 2
Association factors and location of lumbar back pain

Parameters non LP group (N = 32) LP group (N = 77) P

Age (mean±SD) 39.97±12.24 38.47±9.37 NS

Male, no (%) 17 (53.1) 44 (57.1) NS

Weight status, no (%)

•Underweight 1 (3.1) 4 (5.2) NS

•Normal weight 21 (65.6) 34 (44.7) 0.04^*

•Overweight 7 (21.9) 31 (40.7) NS

•Obese 4 (12.5) 8 (10.4) NS

Occupation, no (%)

•Economist 8 (25.0) 16 (20.8) NS

•Engineer 13 (40.6) 19 (24.8) NS

•IT operator 8 (25.0) 35 (45.5) 0.047^*

•Other occupation 3 (9.4) 7 (9.1) NS

Self-reported activity, no (%)

•Sedentary 8 (25) 39 (50.7) 0.014^*

•Active 6 (18.8) 5 (6.5) NS

•Mixt 18 (56.3) 33 (42.9) NS

Referred by

•Doctor, no (%) 17 (53.1) 32 (41.6) NS

Time from onset of symptoms, no (%)

•Less than 1 month 8 (25.0) 20 (26.0) NS

•1–6 months 16 (50) 19 (24.7) 0.01^**

•6 months–1 year 3 (9.4) 12 (15.6) NS

•1–3 years 4 (12.5) 16 (20.8) NS

•More than 3 years 0 (0) 9 (11.7) 0.043^*

Onset of symptoms, no (%)

•Acute 18 (56.3) 27 (35.1) 0.041^*

Localization of pain, no (%)

•Unilateral 17 (53.1) 20 (22.1) 0.001^

•Bilateral 2 (6.3) 6 (7.8) NS

•Central 12 (37.5) 53 (68.8) 0.002^

Sensitive neurological symptoms, no (%) 18 (56.3) 36 (46.8) NS

Motor neurological symptoms, no (%) 7 (21.9) 4 (5.2) 0.014^*

Mechanic type of pain, no (%) 25 (78.1) 67 (87) NS

Continuous type of pain, no (%) 5 (15.6) 15 (19.5) NS

Irradiation type of pain, no (%) 9 (28.1) 29 (37.7) NS

Provocative factors - PC work, no (%) 10 (31.3) 41 (53.3) 0.036^*

Provocative factors - Orthostatic posture, no (%) 14 (43.8) 37 (48.1) NS

Provocative factors - Sport, no (%) 5 (15.6) 20 (26) NS

Provocative factors - Personal hygiene, no (%) 1 (3.1) 10 (13) NS

Posture type, no (%)

•Kyphotic 9 (28.1) 8 (10.4) 0.02^*

•Hyperlordosis 7 (21.9) 56 (72.7) <0.001^***

•Flat-back/sway back 4 (12.5) 13 (16.9) NS

History of trauma, no (%) 12 (37.5) 23 (29.9) NS

Similar previous back problems, no (%) 11 (34.4) 32 (41.6) NS

History of surgery, no (%) 13 (40.6) 35 (45.5) NS

Parameters	non LP group (N = 32)	LP group (N = 77)	P
Age (mean±SD)	39.97±12.24	38.47±9.37	NS
Male, no (%)	17 (53.1)	44 (57.1)	NS
Weight status, no (%)
•Underweight	1 (3.1)	4 (5.2)	NS
•Normal weight	21 (65.6)	34 (44.7)	0.04^*
•Overweight	7 (21.9)	31 (40.7)	NS
•Obese	4 (12.5)	8 (10.4)	NS
Occupation, no (%)
•Economist	8 (25.0)	16 (20.8)	NS
•Engineer	13 (40.6)	19 (24.8)	NS
•IT operator	8 (25.0)	35 (45.5)	0.047^*
•Other occupation	3 (9.4)	7 (9.1)	NS
Self-reported activity, no (%)
•Sedentary	8 (25)	39 (50.7)	0.014^*
•Active	6 (18.8)	5 (6.5)	NS
•Mixt	18 (56.3)	33 (42.9)	NS
Referred by
•Doctor, no (%)	17 (53.1)	32 (41.6)	NS
Time from onset of symptoms, no (%)
•Less than 1 month	8 (25.0)	20 (26.0)	NS
•1–6 months	16 (50)	19 (24.7)	0.01^**
•6 months–1 year	3 (9.4)	12 (15.6)	NS
•1–3 years	4 (12.5)	16 (20.8)	NS
•More than 3 years	0 (0)	9 (11.7)	0.043^*
Onset of symptoms, no (%)
•Acute	18 (56.3)	27 (35.1)	0.041^*
Localization of pain, no (%)
•Unilateral	17 (53.1)	20 (22.1)	0.001^**
•Bilateral	2 (6.3)	6 (7.8)	NS
•Central	12 (37.5)	53 (68.8)	0.002^**
Sensitive neurological symptoms, no (%)	18 (56.3)	36 (46.8)	NS
Motor neurological symptoms, no (%)	7 (21.9)	4 (5.2)	0.014^*
Mechanic type of pain, no (%)	25 (78.1)	67 (87)	NS
Continuous type of pain, no (%)	5 (15.6)	15 (19.5)	NS
Irradiation type of pain, no (%)	9 (28.1)	29 (37.7)	NS
Provocative factors - PC work, no (%)	10 (31.3)	41 (53.3)	0.036^*
Provocative factors - Orthostatic posture, no (%)	14 (43.8)	37 (48.1)	NS
Provocative factors - Sport, no (%)	5 (15.6)	20 (26)	NS
Provocative factors - Personal hygiene, no (%)	1 (3.1)	10 (13)	NS
Posture type, no (%)
•Kyphotic	9 (28.1)	8 (10.4)	0.02^*
•Hyperlordosis	7 (21.9)	56 (72.7)	<0.001^***
•Flat-back/sway back	4 (12.5)	13 (16.9)	NS
History of trauma, no (%)	12 (37.5)	23 (29.9)	NS
Similar previous back problems, no (%)	11 (34.4)	32 (41.6)	NS
History of surgery, no (%)	13 (40.6)	35 (45.5)	NS

LP - lumbar pain; ^*p = 0.05 statistically significant; ^**p = 0.01 highly significant; ^***p = 0.001 extremely significant.

Table 3

Association factors and location of cervical and thoracic back pain

Parameters	non CP group	CP group	p CP	Non TP group	TP group	p TP
	(N = 89)	(N = 20)		(N = 90)	(N = 19)
Age (mean±SD)	39.25±10.73	37.4±7.91	NS	39.08±10.28	38.11±10.41	NS
Male, no (%)	53 (59.6)	8 (40)	NS	55 (61.1)	6 (31.6)	0.018^*
Weight status, no (%)	5 (5.6)	0	-	3 (3.3)	(10.5)	NS
•Underweight	41 (46.1)	14 (70)	NS	48 (53.3)	7 (36.8)	NS
•Normal weight	32 (36.0)	6 (25)	NS	31 (34.4)	7 (36.8)	NS
•Overweight Obese	11 (12.4)	1 (5)	NS	9 (10.0)	3 (15.8)	NS
Occupation, no (%)
•Economist	20 (22.5)	4 (20)	NS	15 (16.7)	9 (47.4)	0.003^**
•Engineer	29 (32.6)	3 (15)	NS	30 (33.3)	2 (10.5)	0.047^*
•IT operator	34 (38.2)	9 (45)	NS	36 (40)	7 (36.8)	NS
•Other occupation	6 (6.7)	4 (20)	NS	9 (10)	1 (5.3)	NS
Self-reported activity, no (%)
•Sedentary	37 (41.6)	10 (50)	NS	36 (40.0)	57. 9)	NS
•Active	7 (7.9)	4 (20)	NS	10 (11.1)	(5.3)	NS
•Mixt	45 (50.6)	6 (30)	NS	44 (48.9)	7 (36.8)	NS
Referred by
•Doctor, no (%)	35 (39.3)	14 (70)	0.013^*	42 (46.7)	7 (36.8)	NS
Time from onset of symptoms, no (%)
•Less than 1 month	25 (28.1)	3 (15)	NS	24 (26.7)	4 (21.1)	NS
•1–6 months	24 (27.0)	11 (55)	0.015^*	28 (31.1)	7(36.8)	NS
•6 months–1 year	14 (15.7)	1 (5)	NS	11 (12.2)	(21.1)	NS
•1–3 years	16 (18)	4 (20)	NS	17 (18.9)	3 (15.8)	NS
•More than 3 years	8 (9)	1 (5)	NS	8 (8.9)	1 (5.3)	NS
Onset of symptoms, no (%)
•Acute	37 (41.6)	8 (40)	NS	38 (42.2)	7 (36.8)	NS
Localization of pain, no (%)
•Unilateral	34 (38.2)	3 (15)	0.048^*	35 (38.9)	2 (10.5)	0.018^*
•Bilateral	7 (7.9)	1 (5)	NS	7 (7.8)	(5.3)	NS
•Central	49 (55.1)	16 (80)	0.04^*	50 (55.6)	15 (78.9)	NS
Sensitive neurological symptoms, no (%)	41 (46.1)	13 (65)	NS	44 (48.9)	10 (52.6)	NS
Motor neurological symptoms, no (%)	7 (7.9)	4 (20)	NS	9 (10)	2 (10.5)	NS
Mechanic type of pain, no (%)	73 (82)	19 (95)	NS	77 (85.6)	15 (79)	NS
Continuous type of pain, no (%)	17 (19.1)	3 (15)	NS	15 (16.7)	5 (26.3)	NS
Irradiation type of pain, no (%)	31 (34.8)	7 (35)	NS	36 (40)	2 (10.5)	0.014^*
Provocative factors - PC work, no (%)	41 (46.1)	10 (50)	NS	41 (45.6)	10 (52.4)	NS
Provocative factors - Orthostatic posture, no (%)	46 (51.7)	5 (25)	0.031^*	47 (52.2)	4 (21.1)	0.013^*
Provocative factors - Sport, no (%)	22 (24.7)	3 (15)	NS	22 (24.4)	2 (15.8)	NS
Provocative factors - Personal hygiene, no (%)	9 (10.1)	2 (10)	NS	10 (11.1)	1 (5.3)	NS
Posture type, no (%)
•Kyphotic	7 (7.9)	10 (50)	<0.001^**	12 (13.3)	4 (26.3)	NS
•Hyperlordosis	60 (67.4)	3 (15)	^<0.001^*	57 (63.3)	6 (31.6)	0.011^**
•Flat-back/sway back	11 (12.4)	6 (30)	^0.049^	7 (7.8)	10 (52.6)	<0.001^***
History of trauma, no (%)	27 (30.3)	8 (40)	NS	32 (35.6)	3 (15.8)	NS
Similar previous back problems, no (%)	36 (40.4)	7 (35)	NS	33 (36.7)	10 (52.6)	NS
History of surgery, no (%)	40 (44.9)	8 (40)	NS	43 (47.8)	5 (26.3)	NS

TP - thoracic pain; CP - cervical pain; IT- information technology; PC – personal computer; ^*p = 0.05 statistically significant; ^**p = 0.01 highly significant; ^***p = 0.001 extremely significant.

This study showed that IT operators had an increased risk for low back pain OR = 2.5 CI 95% (1.1; 6.256), p = 0.047 compared with patients without low back pain, and economists had a higher risk for cervical pain OR = 4.5 CI 95% (1.56; 12.95), p = 0.003. The sitting position during PC work increased the risk for low back pain OR = 2.506 CI 95% (1.048; 5.98), p = 0.036, the orthostatic position showed to be a decreasing factor for thoracic pain OR = 0.241 CI 95% (0.075; 0.792), p = 0.013 and also for cervical pain OR = 0.312 CI 95% (0.104; 0.931), p = 0.031. The subjects who self-reported sedentary activity showed to be at risk to develop low back pain OR = 3.079 CI 95% (1.23; 7.69), p = 0.014.

Normal weight showed to be a protective factor for low back pain OR = 0.41 CI 95% (0.71; 0.97), p = 0.041 with kyphosis posture being an increasing factor for cervical pain OR = 11.72 CI 95% (3.64; 37.66), p < 0.001. Hyperlordosis was a risk factor for low back pain OR = 9.52 CI 95% (3.58; 25.292), p < 0.001 and a protective factor for thoracic pain OR = 0.267 CI 95% (0.093; 0.770), p = 0.011 and for cervical pain OR = 0.085 CI 95% (0.023; 0.315), p < 0.001. The position of flat back/sway back was a risk factor for thoracic pain OR = 13.175 CI 95% (4.025; 43.123), p < 0.001 and for cervical pain OR = 3.039 CI 95% (1.12; 9.559), p = 0.049.

4 Discussions

Sedentary self-declared computer workers had a higher risk to develop low back pain [OR = 3.079, CI 95% (1.23; 7.69) p = 0.014]. Positive signs of compression syndrome in the studied group, such as pain, paraesthesia, hyperesthesia, and allodynia, were patient-reported with no delay from the onset. This study strengthens other papers’ results on the effect of sedentary activities on the musculoskeletal system, back pain being more likely to occur in this category of individuals [8, 16]. Regular assessments and even employee training in proper ergonomics, posture and physical activity could improve health status and reduce disability in computer workers. Office facilities for PC workers should be rigorously evaluated by the occupational physician and the ergonomist order to optimize comfort, reduce symptoms at work and to increase further performance [17]. Other studies mentioned that low back pain and thoracic pain in PC workers that did not benefit from an ergonomic intervention showed an increment of symptoms in time [18].

Low back pain often becomes difficult to treat when neurological complications appear. When radiculopathy is associated, work absenteeism and even work reconversion or abandon might increase. The negative signs related to paresis/compression syndrome such as hypoesthesia, anaesthesia and absence of pain were not reported after the onset, thereafter predisposing patients to late recognition of their diagnosis class and further intervention. As neurological complications of low back pain might take different appearances that could make patients unaware of their problem, we consider basic medical education of computer workers to be part of their routine training. In this group, severe neurological symptoms with positive signs were patient-reported immediately after the onset, while mild symptoms and neurological symptoms with negative signs were reported with delay. Low back pain complications, if recognized in the initial stages, could benefit from proper medical approach with possible work absenteeism reduction [19]. Work absenteeism related to back pain and its complications have an important economic impact [20, 21]. Workplace health promotion involves education in ergonomics, recognition of typical work-related diseases and their initial signs and possible complications and addressing to the occupational physician for assessment and referral to the appropriate medical department for treatment.

The MRI investigation was presented upon the first physical therapy visit in 57.8% with no previous physician diagnosis, meaning that personal computer (PC) workers in Romania often ask for imagistic opinion overpassing the clinical medical assessment. There is a high tendency of subjects to skip the evaluation of the occupational physician and to address directly for physical therapy. More than half of our study participants used friends’ recommendations or the internet for physiotherapy to select their treatment option directly.

The symptoms were not independent when body assessment was performed in orthostatic position, hyper lordosis in the lumbar spine being predominant (64.9%). Patients who were diagnosed with hyper lordosis in orthostatic position showed to have a flexed lumbar spine when assessed in sitting. Therefore, when assessing a PC worker who experiences low back pain, we should consider evaluating not only the orthostatic posture, but also the specific activity posture to better understand the mechanisms of pain and further rehabilitation program. One study analysing office workers showed no changes in the spinal sagittal alignment when measured during a complete working day [22]. This could explain that pain mechanisms are not spinal curvature related, therefore more factors could be responsible for the symptoms. Posture analysis alone brings insufficient information to explain back pain in office workers. Active breaks and changing one’s posture showed to have positive effects regarding pain and discomfort [23]. Most of our study subjects reported small numbers of breaks during the working day. To prevent back pain, ergonomic assessment of the sitting position for PC workers should be followed by break recommendations. Back pain can affect the overall well-being of employees. A Slovenian study proved that working conditions and especially the number of hours are correlated with worker well-being [24]. A pilot study conducted in Poland on specialists in the IT industry showed that high pay, interesting projects, professional development, and organization of working conditions were the main motivating work factors. No remarks on physical well-being or specific ergonomic elements were mentioned other than the number of hours and remote work [25].

In the population practising endurance sports, less irradiating low back pain was identified, but no indications on their routine at work was mentioned in the study [26]. A provocative factor, for many of our study subjects, was playing sports. Out of 11 PC workers involved in endurance sports (cycling and running), six experienced irradiating low back pain. We can suspect that endurance sports in sedentary types of jobs could be a risk factor for developing irradiating low back pain. For active people involved in sedentary types of jobs, functional assessment and musculoskeletal screening in the physical-therapy department should be taken into consideration to prevent the occurrence of back pain or any worsening of pre-existing pain. Patients reported their participation in sports as a hobby in 53.21%, but only 10% really admitted being active people. We can conclude that in the study group the self-estimation of the physical activity level was misunderstood or that they did not have a regularly active life at all.

From the point of view of the smoking rate of the patients, there are no considerable differences between the adult general population reported by the World Health Organization (WHO) statistics and our group [27].

The limitations of the study were: a retrospective study, a small sample of analysed medical records, not enough information regarding the occupational risk factors and the ergonomics at the workplace.

5 Conclusions

The sedentary PC workers in the study had a higher risk to develop low back pain. More than half of the analysed files revealed that physiotherapy was the first medical department that patients addressed to for back pain. Therefore, we recommend that all signs of musculoskeletal disorders be reported to the occupational health department ever since the onset of any symptoms. When assessing the PC workers’ posture, the sitting position should be considered as well. The physical activity level in PC workers should benefit of specific measuring procedures. More data on physical activity, work-related risk factors and ergonomics need to be recorded when PC workers are assessed in a physiotherapy unit.

The presence of the ergonomist can be an active contributed factor for improving the workplace conditions of PC workers. The need for a complex team that consists of an occupational physician, an ergonomist, and a physiotherapist in preventing and controlling back pain in computer workers should be better implemented. The role of physiotherapy and the occupational medical assessment from the very initial signs of back pain in PC users should be further explored.

Author contributions

CONCEPTION: Iulia Iovanca Drăgan and Florina Georgeta Popescu

INTERPRETATION OR ANALYSIS OF DATA: Ramona Anculia, Pompilia Camelia Lăzureanu, Florina Georgeta Popescu and Iulia Iovanca Drăgoi

PREPARATION OF THE MANUSCRIPT: Ramona Anculia, Ioana Marin, Melania Ghigulescu, Florina Georgeta Popescu and Iulia Iovanca Drăgoi

REVISION FOR IMPORTANT INTELLECTUAL CONTENT: Elena-Ana Păuncu, Iulia Iovanca Drăgoi and Florina Georgeta Popescu

SUPERVISION: Elena -Ana Păuncu, Iulia Iovanca Drăgoi and Florina Georgeta Popescu

Conflict of interest

The authors declare that there were no conflicts of interests.

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