Ergonomic evaluation of the risk factors causing pain in the upper part of the body among IT professionals in India

Abstract

BACKGROUND:

In developing countries, the recent increase in computer-related work has considerably increased the occupational complaint of pain.

OBJECTIVE:

To examine the effects of workstation design, posture and ergonomic awareness on the prevalence of pain for a year in the upper part of the body (eyes, hands, arms, shoulders, lower back, and upper back) among IT professionals in India.

METHOD:

To investigate the association of risk factors with the prevalence of pain in different body parts, a newly designed online questionnaire titled “A Questionnaire based on ergonomics for IT Professionals” was developed. The psychometric properties of this questionnaire were tested. 110 computer office workers were recruited from IT companies from major cities in India.

RESULTS:

The confirmation of reliability and lack of redundancy of items was provided by the calculation of internal consistency (Cronbach’s alpha 0.804) and cross-validation. 60% of participants was male. Mean age was 29.73±6.09 years. The prevalence of pain for a year in the upper part of the body was 38.2%. The frequently reported pains were in the neck (22.7%), lower back area (22.7%), and eye strain (21.8%).

CONCLUSION:

It was identified that long working hours, excessive usage of smartphones, lack of exercise, incorrect workstation adjustments, and incorrect posture were the risk factors for the prevalence of pain.

Keywords

Computer workers ergonomics risk-factors work postures computer workstation

1 Introduction

The National Association of Software and Services Companies (NASSCOM) in 2010 stated that the Indian information technology industry, including IT and IT-enabled services, has grown from USD 4 Bn in the year 1998 to USD 52 Bn in 2008. In 2019, NASSCOM stated that the revenue crossed USD 165 Bn. The need to use computers increases as computer technology advances and software and computer packages are being developed. People are an essential part of every Information Technology (IT) company and critical to delivering quality services, and hence, the performance of an organization is directly related to the health conditions of its employees. A Shikdar et al. reported that occupational health and safety problems are continuously increasing among computer users [1]. Due to increased globalization and industrial advancements, researchers have concluded that work-related musculoskeletal disorders were prevalent amongst Indian software professionals [2]. The researchers have recommended that a precise risk assessment of the computer workstation is needed.

The concept of total safety, health and productivity are directly related to various factors like physical, physiological, postural and environmental [3]. The development of musculoskeletal disorders among IT professionals are due to the awkward posture adopted by them during work [4, 5]. The computer work is sedentary and it develops static stress in the body, leading to loss of strength, flexibility, and endurance [3]. Static stress and awkward posture are developed due to lack of various physical factors –improper backrest, no armrest on the chair, improper positioning of the monitor, keyboard and mouse, and uncomfortable workstation [6 –9]. It is also confirmed that the risk factors associated with constant use of computers include physical, ergonomic factors such as desk, chair and screen height and working posture [7, 10], and the use of input device such as the computer mouse [11, 12]. The prevalence of musculoskeletal symptoms among keyboard users have been reported to be as high as 76% [10]. Compu-ter use for more than 4–6 hours was the most critical predictor of work-related neck pain followed by work-related factors such as the height of the screen and posture. It was identified that there was an association between the prevalence of work-related complaints of arm, neck, and shoulder and work-related risk factors (workstation, body posture, break time and social support), duration of hours using a computer and levels of ergonomic knowledge among office workers in Malaysia [13].

There is, however, a dearth of studies reporting the prevalence of pain among Indian IT professionals. The studies that identified specific work-related factors (computer workstation design, incorrect work postures, and ergonomic awareness) that lead to pain are limited in the literature. It was also noticed that with the advancement in technology, IT professionals use different devices like desktops, laptops, tablets, or smartphones at work.

The research questions thus put forth for this study were as follows:

Which type of device was predominantly used at work and home, and which device influenced more pain?

What was the 1-year prevalence of pain in the upper part of the body among the participants, and which upper part body region frequently reported pain?

What were the deficiencies in computer workstation design that led to pain in the upper part of the body?

What were the current risk factors (among daily computer usage, duration of the occupation, type of device at work, ergonomic information and training, no habit of exercise and age) that caused pain in the upper part of the body?

What were the incorrect postures while working with the monitor, keyboard, mouse, armrest, wrist rest, and chair that led to pain in the upper part of the body?

The main aim of this study was to identify the current risk factors for occupational pain related with incorrect work habits, the awareness of ergonomic practices, computer unit postures and effects of workstation design among Indian IT employees.

2 Methods

2.1 Study participants

The survey was carried out between May 2016 and November 2016 [14]. One hundred and fifty computer office workers from Indian multinational IT companies from major cities like Delhi, Hyderabad, Chennai, Bangalore, and Mysore were invited for this study. The online questionnaire was shared with the alumni of the Karunya Institute of Technology and Sciences working in Indian IT companies via emails and social media. Informed consent was obtained from each participant. The respondents in this survey were included based on the following criteria (1) Working in the current position for at least one year (2) spends at least two hours per day working on the computer; (3) not afflicted from sickness and injury affecting the musculoskeletal system; (4) with no history of surgery in the upper musculoskeletal part of the body. One hundred and ten participants who satisfied the inclusion criteria were considered for the study.

2.2 Study instruments

In the recent past, it was noticed that IT employees predominantly used desktops as well as laptops in their workplace. It was found from the literature that there were different questionnaires designed and developed to acquire data from the computer users to assess physical, psychosocial and environmental factors, and demographic characteristics of the computer workstation. Moreover, there were other questionnaires developed to find the complaint of pain in different body regions. Also, instead of asking the computer users to fill 2 or 3 questionnaires, a new on-line questionnaire was designed to collect demogra-phic, employment, physical workstation, complaints of pain and work environment information. Moreover, very few online questionnaires were available to assess a computer workstation and the prevalence of pain. Eight questions were added to assess the adjustability feature of the armrest, monitor, keybo-ard tray and mouse tray. Five questions were added on the design of the wrist pad. Eight questions were added to acquire information on the amount of time spent per day on coding/typing, computer aided design, animation, meetings, video conferencing, tea-ching, reading and talking on the phone.

An online questionnaire titled “A Questionnaire based on ergonomics for IT Professionals (QEIP)” was developed to collect the most accurate and re-levant information to know the occupational health of employees of offices, banks, and IT sector. The validated tool Maastricht Upper Extremity Questionnaire (MUEQ) [15] and the Occupational Safety and Health Administration (OSHA) checklist (USA) (https://www.osha.gov/SLTC/etools/computerworkstations/checklist_evaluation.html) were referred to formulate this customized questionnaire. This Questionnaire was designed to identify pain experienced in the upper part of the body and to find the risk factors for the prevalence of pain. According to the time study done, it took approximately 15 minutes to fill out the questionnaire.

The pilot study was conducted on 30 employees, and the reliability test was carried out on the newly designed questionnaire. The Cronbach’s Alpha was found to be acceptable (Cronbach’s Alpha = 0.804). Based on the review by experts and the results of the pilot study, redundant and irrelevant questions were removed, and some of the questions were re-framed.

The QEIP is a 98-item survey. Five sections co-ver the following areas: demographic informat-ion, employment information, physical work station characteristics, ergonomic injury-related symptoms (complaints), and work environment. The first section (Demographic Information) consisted of questions related to the demographics of the computer user. The second section, ‘employment information’ covered questions related to the duration of occupation, daily computer usage, type of computer tasks performed, and the nature of breaks during work. A set of questions was used in this section to evaluate the awareness of ergonomic principles used in the workplace by the IT employees. The third section of the QEIP questionnaire, ‘Physical Work Station Characteristics’ is a 40-item self-report dichotomous checklist, which evaluates the available workstation equipment and risk factors related to workstation postures. This section identified specific risks for symptoms related to posture of the neck, head, shoulders, trunk, and seating issues. This section of the questionnaire also recognized risks associated with the position of the keyboard, mouse, monitor, armrest and wrist rest, and lack of hands-free telephone headset a document holder. The fourth section, ‘ergonomic injury-related symptoms (complaints)’ comprises dichotomous questions related to a complaint of pain in the upper part of the body and severity of pain. A set of questions related to the type of treatment received and the duration of exercise were also included in this section. The fifth section, ‘work environment’ includes dichotomous questions related to the environment (temperature, ventilation, illumination, and noise) of the computer workstation.

The QEIP evaluates risk factors in the following domains: gender, daily computer usage, duration of the occupation, type of device, ergonomic information, ergonomic training, exercise, age, workstation, and body posture. The dependent variable was the incidence of pain in the neck, eye, upper and lower back, right and left shoulder, elbow, upper arm, forearm and hands prevailing for at-least seven days over the past one year. The analysis of risk factors was performed for each area autonomously.

2.3 Statistical methods

Table 1
Characteristics of the study population

Variable All Males Females

Age

21 –30 years 65(59.00%) 42(64.6%) 23(35.5%)

31 –40 years 40(36.36%) 19(47.5%) 21(52.5%)

41 –50 years 4(36.36%) 4(100%) 0(0%)

51 –60 years 1(0.9%) 1(100%) 0(0%)

Number of working years in the current position

1–5 years 103(93.6%) 63(61.2%) 40(38.8%)

6–10 years 7(6.4%) 3(42.9%) 4(57.7%)

Number of working hours with a computer per day

2–5 hours 2(18.18%) 2(100%) 0

6–9 hours 95(86.3%) 57(60%) 38(40%)

10–13 hours 13(11.8%) 7(53.8%) 6(46.2%)

Variable	All	Males	Females
Age
21 –30 years	65(59.00%)	42(64.6%)	23(35.5%)
31 –40 years	40(36.36%)	19(47.5%)	21(52.5%)
41 –50 years	4(36.36%)	4(100%)	0(0%)
51 –60 years	1(0.9%)	1(100%)	0(0%)
Number of working years in the current position
1–5 years	103(93.6%)	63(61.2%)	40(38.8%)
6–10 years	7(6.4%)	3(42.9%)	4(57.7%)
Number of working hours with a computer per day
2–5 hours	2(18.18%)	2(100%)	0
6–9 hours	95(86.3%)	57(60%)	38(40%)
10–13 hours	13(11.8%)	7(53.8%)	6(46.2%)

Note. The demographics of the respondents are listed.

Fig. 1

The percentage of devices predominantly used at work and home are represented.

Independent sample t-test was carried out to find the association between pain and gender. One Way ANOVA test was carried out to examine the relationship of risk factors i.e., daily computer usage, duration of occupation, type of device, ergonomic information, ergonomic training, exercise, and age separately with pain in the upper part of the body. Chi-square test was conducted to examine the association of the design of computer workstation (Monitor, Keyboard, mouse, chair, armrest, and wrist rest) and body posture with pain in different body regions. The complete data was entered and cross-verified for consistency. SPSS version 20.0 (IBM SPSS Statistics Version 20.0) statistical software package was used to analyze the data, and p < 0.05 was considered statistically significant.

3 Results

3.1 Demographic characteristics

The sample size was 110 participants. Mean age was 29.73±6.09 years (range 21–58 years), and 60% responses were from male candidates. The age of 59% of the study population was between 21–30 years, out of which 64.6% was males, and 35.5% was females. 97.3% of the study population was right-handed. A majority of the study population was employed between 1–5 years (93.6%) and 6.4% of them had already worked between 6–10 years in their current position. 61.2% of the male respondents worked 1–5 hours per day on a computer, compared to 38.8% of the female participants. The demographic characteristics of the study population are summarized in Table 1.

3.2 Physical workstation characteristics

The devices which were predominantly used at work were desktop (43%) and laptops (36%) whereas the devices which were predominantly used at home were laptops (44%) and tablets (41%) (Fig. 1). Out of the 72 respondents who used laptops, 33.3% connected a keyboard, 58.3% connected a mouse, 15.2% were able to adjust the plugged-in keyboard and mouse height and 69.4 % placed their laptops on a platform so that the display was at a comfortable height as shown in Fig. 2.

Fig. 2

The percentage of the respondents who worked on laptops connected with a standard size keyboard and mouse used a height adjustable keyboard tray and mouse tray, and placed their laptops on a platform so that the display was at a comfortable height are shown.

3.3 Prevalence of pain in eye, arm, neck, shoulder, and back

The 1-year prevalence of pain in eye, arm, neck, shoulder, and back among the participants was 38.2%. Complaint of pain in males and females was 34.85% and 43.18% respectively. The frequently reported pain was in the neck (22.7%), lower back (22.7%), eye strain (21.8%), upper back (13.6%) and shoulder (12.7%) as presented in Fig. 3. The participants were divided into two sub-groups based on their complaints of pain in upper extremities: (1) mild cases: subjects who reported that the pain disappeared after a short rest; (2) severe cases: subjects who reported that the pain continued after work and even after a short rest. Most of the subjects in the study population reporting pain had mild symptoms (74%), whereas only 26% complained of severe symptoms.

Fig. 3

The percentages of the 1-year prevalence of pain in different body regions among the participants are represented.

The general symptoms among those with complaints in the upper musculoskeletal part of the body was pain (83.3%), fatigue and exhaustion (90.4%), stiffness (95.2%), numbness (95.2%) and tingling sensation (92.8%) and weakness (92.8%). Among the participants with complaints, 42.8% (n = 42) had taken treatment from a hospital for their illnesses. The treatment included physiotherapy in 28.5%, medication in 9.5% and other treatments in 4.7%. In addition, 28% (n = 12) reported complaints was absenteeism from work and for n = 34 reported complaints (Work-38%, Leisure-42%, Work and Leisure-31%), the normal activities were affected.

3.4 Workstation evaluation

Table 2
Risk factors verses pain complaints

Risk factors p value

Gender 0.308

Daily computer usage 0.029^*

Duration of occupation Current position: 0.182,

IT field: 0.211

Type of device at work Smartphone –0.03^*

Ergonomic information 0.868

Ergonomic training 0.365

Exercise 0.003^**

Age 0.365

Risk factors	p value
Gender	0.308
Daily computer usage	0.029^*
Duration of occupation	Current position: 0.182,
	IT field: 0.211
Type of device at work	Smartphone –0.03^*
Ergonomic information	0.868
Ergonomic training	0.365
Exercise	0.003^**
Age	0.365

Note. The p value obtained from the independent sample t test and one-way ANOVA test done on the risk factors for the prevalence of pain are listed and a value of p < 0.05 is considered significant and p < 0.01 is considered highly significant.*p<0.05. **p<0.01.

Table 3

Deficiencies identified in computer workstation design

Deficiency in computer workstation design	Percent of cases	Item number
Document holder not provided	69.10%	38
Mouse height was not adjustable	67.30%	25
Wrist rest not provided	60.00%	39
Feet were not supported by a stable footrest	58.20%	9b
Telephone did not have a head-set	56.40%	37
Difficulty in keeping trunk perpendicular	40.00%	3
Keyboard height was not adjustable	36.40%	22
Wrist rest not gel-filled	36.40%	39d
Foot not resting on the ground	33.60%	9a
Awkward position of shoulders and arms	31.80%	4
Forearm rest height not adjustable	31.80%	17
Monitor height was not adjustable	31.80%	33
Trouble in keeping wrists and hands straight	30.90%	7
Unable to adjust the position of the keyboard (front and back)	30.00%	23
Poor design of wrist rest (beaded)	30.00%	39a
Elbow and upper arm away from the trunk	29.10%	5
Unable to adjust the position of the keyboard (left and right)	28.20%	24
Bent head and neck	27.70%	1
Thighs not parallel to the floor	25.50%	8
Forearms and wrists not straight	20.90%	6
Wrist rest not padded	20.90%	39c
Seat front pressing against rear of knees	19.10%	12
Difficulty in working simultaneously	16.40%	35
with computer and telephone
Insufficient seat width and length	14.50%	11
Forearm and wrist on top of a hard or sharp edge	14.50%	21
No provision for moving the mouse left and right	14.50%	27
Glare present on the screen	14.50%	32
Non-supportive backrest	13.60%	10
Non-supportive armrest	13.60%	14
No provision for moving the mouse front and back	13.60%	26
The telephone was not within easy reach	13.60%	36
Improper placement of document holder	12.70%	38b
Seat cushion poorly designed	11.80%	13
Improper placement of wrist rest	11.80%	39b
Input devices placed incorrectly	10.90%	19
Top of the monitor above the level of the eye	10.90%	28
Unsuitable/unfitting variety of keyboard and mouse	10.00%	20
The non-neutral position of head, neck, and trunk	8.20%	2
Monitor distance being too far	7.30%	30
Input device stand unstable	6.40%	18
Not given the required clearance space below the computer desk	5.50%	34
Chair height not adjustable	4.50%	15
Chair not fitted on rollers	4.50%	16
Monitor not being placed directly in front	3.60%	31
Trouble in working while using spectacles	2.70%	29
Non-stable document holders	2.70%	38a
Poor maintenance of equipment	5.90%	40

The employees who worked with wrongly adjusted office equipment were at larger risk of developing job-related musculoskeletal disorders. The ergono-mic principles were not known to many of the emp-loyees. Since the anthropometry data differed from place to place, it was required to find the condi-tion of the working environment and deviations from the standard ergonomics practices. The workstation was evaluated with the modified OSHA VDT workstation checklist which was integrated into the newly designed questionnaire QEIP in the section called “Physical Workstation Characteristics,” and the issues faced in the workstation are prioritized and presented in Table 3. As shown in Table 3, the leading deficits recognized in computer unit design with respect to an IT employee were; mouse height was not adjustable (67.30%), wrist rest was not pro-vided (60.00%), feet were not supported by a stable footrest (58.20%), difficulty in keeping trunk perpendicular (40.00%), keyboard height was not adj-ustable (36.40%), foot was not resting on the ground (33.60%), awkward positions of shoulders and arm during computer task (31.80%), absence of armrests or non-adjustable height of the armrest (31.80%) and elbow and upper arm away from the trunk while working (29.10%). The above-mentioned deficiencies in workstation design usually led to pain and discomfort in the neck, shoulders, forearm, and wrists.

3.5 Potential risk factors of pain

Table 4
Monitor position verses pain in different body regions

Monitor position Eye strain Neck Lower back Shoulder Upper/lower arm Wrist Hand

Monitor distance being too far 0.402 0.013^* 0.157 0.001^ 0.408 0.247 0.247

Monitor not being placed directly in front 0.000^ 0.000^ 0.001^ 0.023^* 0.001^ 0.003^ 0.000^**

Monitor position	Eye strain	Neck	Lower back	Shoulder	Upper/lower arm	Wrist	Hand
Monitor distance being too far	0.402	0.013^*	0.157	0.001^**	0.408	0.247	0.247
Monitor not being placed directly in front	0.000^**	0.000^**	0.001^**	0.023^*	0.001^**	0.003^**	0.000^**

Note. This table shows the association between the design of monitor with pain in the respective body regions mentioned in the column heading (eye, neck, lower back, shoulder, upper/lower arm, wrist, and hand). ^*p<0.05. ^**p<0.01.

An independent sample t-test was conducted to find the association between pain experienced and gender. The p = 0.308 (p > .05) (Table 2), indicated that males and females have a similar prevalence of pain. A One Way ANOVA test was carried out to examine the relationship of daily computer usage with pain in the upper part of the body. As shown in Table 2, using the computer for a long time per day led to significant pain in the upper part of the body (p = 0.029). The 1-year prevalence of pain for those who worked on desktops at work was 38.81%, on laptops was 37.50%, on tablets was 20% and on smartphones was 55.56%. It was found from Table 2 that the p-value gained for those working on the smartphone was 0.03, which was statistically significant (p < 0.05). This indicated that people who predominantly worked on smartphones were more inclined to discomfort and pain. From Table 2, it was found that the p-value for the people who did not exercise regularly was 0.003, which was significant. This indicated that the people who exercised regularly had less pain in the upper part of the body. It was also found from Table 2 that, the association between duration of the occupation, ergonomic information, ergonomic training, and age with pain were not significantly associated with pain. This indicated that the main risk factors for the pain were long hours of working, regular usage of smartphone, and lack of regular exercise.

Table 5

Design of the chair verses pain in different body regions

Design of the chair	Eye strain	Neck	Wrist
Chair height not adjustable	0.001^**	0.042^*	0.004^**
Chair not fitted on rollers	0.035^*	0.042^*	0.004^**

Note. The association between the design of the chair with pain in the respective body regions mentioned in the column heading (eye, neck, and wrist) is presented in this table. ^*p<0.05. ^**p<0.01.

Table 6

Position of keyboard verses pain in different body regions

Position of keyboard	Eye strain	Upper back	Right and left shoulder
Keyboard height was not adjustable	0.000^**	0.041^*	0.008^**
Unable to adjust the position of the	0.690	0.368	0.046^*
keyboard (front and back)
Unable to adjust the position of the	0.530	0.890	0.029^*
keyboard (left and right)

Note. The association between the design of a keyboard stand with pain in the respective body regions mentioned in the column heading (eye, upper back, and right and left shoulder) is presented in this table. ^*p<0.05. ^**p<0.01.

3.5.1 Risk factors related to monitor position

From Table 4, through Chi-square statistical test, it was reported that the significant p-value (p < .05) confirms the association between the position of the monitor and pain in pain in the upper part of the body. As shown in Table 4, the monitor placed far from the user, led to pain in the neck and shoulders and the monitor placed not directly in front of the user while working, led to pain in eye, neck, lower back, shoulders, upper and lower arm, wrist, and hand.

Table 7
Position and design of the mouse verses pain in different body regions

Position and design of the mouse Right shoulder Right upper arm Right wrist Right hand

Input devices placed incorrectly 0.668 0.543 0.10^* 0.10^*

Unsuitable/Unfitting variety of 0.129 0.001^ 0.006^ 0.006^

keyboard and mouse

Mouse height is not adjustable 0.005^ 0.228 0.041^* 0.158

No provision for moving the mouse 0.368 0.006^ 0.423 0.423

front and back

No provision for moving the mouse 0.439 0.009^ 0.405 0.405

left and right

Position and design of the mouse	Right shoulder	Right upper arm	Right wrist	Right hand
Input devices placed incorrectly	0.668	0.543	0.10^*	0.10^*
Unsuitable/Unfitting variety of	0.129	0.001^**	0.006^**	0.006^**
keyboard and mouse
Mouse height is not adjustable	0.005^**	0.228	0.041^*	0.158
No provision for moving the mouse	0.368	0.006^**	0.423	0.423
front and back
No provision for moving the mouse	0.439	0.009^**	0.405	0.405
left and right

Note. The association between the design of the mouse with pain in the respective body regions mentioned in the column heading (right shoulder, upper arm, wrist, and hand) is presented in this table. ^*p<0.05. ^**p<0.01.

3.5.2 Risk factors related to the design of the chair

The association between the design of chair and pain in the upper part of the body was found by performing the Chi-square test, and the p values obtained were listed in Table 5. It was inferred from Table 5 that IT professionals using chairs with non-adjustable height and chairs not fitted on rollers reported pain in eye, neck, and wrist. In Table 3, only 13.6 % of the users were using a chair with non-supportive backrest. Hence, the majority of the IT professionals were provided with a chair with backrest supporting the lower back.

3.5.3 Risk factors related to keyboard position

The association between the position of keyboard and pain in the upper part of the body was found by performing the Chi-square test, and the p values obtained were listed in Table 6. The researchers inferred from Table 6 that the users having no provision to adjust the height of the keyboard developed pain in the eye, upper back, and left and right shoulders. It was also indicated with no provision to move the keyboard in the left-right, and front-back directions to the user, led to pain in shoulders.

3.5.4 Risk factors related to the position and design of the mouse

A Chi-square test was carried out to find the association between the position and design of the mouse to the user and the pain experienced by the user in pain in the upper part of the body. From Table 7, it was understood that an unfitting variety of the design of the mouse would also lead to pain in right upper arm, wrist, and hand. It was also inferred that the mouse placed in incorrect position led to the right wrist and hand pain. Furthermore, the researchers inferred from Table 7 that the users having no provision to adjust the height of the mouse developed pain in right shoulder and wrist. It was also made known that no provision to adjust the position of the mouse in different directions (front, back, left and right) led to pain in the right upper arm.

3.5.5 Risk factors related to the design of the armrest

The statistical test, Chi-square test was carried out to find the association between the design of armrest and the pain experienced by the user in different body parts. From Table 8, it was found that since the p-value is significant (p < .05), working on a computer with arms not supported can lead to pain in the left and right wrist as well as the hand.

3.5.6 Risk factors related to the design of wrist rest

From the Table 9, through the Chi-square statistical test, it was reported that the significant p-value (p < .05) confirms the association between the design of wrist rest and pain in some of the body regions. As shown in Table 9, it indicated that improper placement of wrist rest and using a wrist rest filled with beads developed pain in the left and right forearm. It can also be seen from Table 9 that wrist resting on sharp edge led to pain in left and right hand and wrist.

Table 8
Design of arm rest verses pain in different body regions

Design of arm rest Left and right wrist and hand Left and right upper arm

Non-supportive armrest 0.031^* 0.321

Forearm rest height 0.431 0.060

not adjustable

Design of arm rest	Left and right wrist and hand	Left and right upper arm
Non-supportive armrest	0.031^*	0.321
Forearm rest height	0.431	0.060
not adjustable

Note. The association between the design of arm rest with pain in the respective body regions mentioned in the column heading (left and right upper arm, wrist, and hand) is presented in this table. ^*p<0.05. ^**p<0.01.

Table 9

Design of wrist rest verses pain in different body regions

Design of wrist rest	Left and right forearm	Left and right hand	Left and right wrist
Improper placement of	0.024^*	0.361	0.361
wrist rest
Wrist resting on	0.560	0.041^*	0.041^*
a sharp edge
Poor design of	0.023^*	0.755	0.755
wrist rest (beaded)

Note. ‘^*’ denotes p < .05 which indicates that there was an association between the design of wrist rest with pain in the respective body regions mentioned in the column heading (left and right forearm, hand and wrist) is presented in this table. Designs with no provision for wrist rest and gel-filled wrist rests were insignificant and hence were not included in the table. ^*p<0.05. ^**p<0.01.

Table 10

Posture verses pain in different body regions

Incorrect posture	Eye strain	Neck	Lower back	Shoulder	Upper/lower arm	Wrist	Hand
Head and neck bent while working	0.001^**	0.008^**	0.001^**	0.041^*	0.004^**	0.001^**	0.001^**
Trunk leaning forward/backward	0.111	0.358	0.000^^	0.004^**	0.002^**	0.012^*	0.012^*
Shoulders and upper arms were	0.000^**	0.013^*	0.013^*	0.005^^	0.005^^	0.006^^	0.003^^
stretched forward and elevated

Note. The association between the incorrect posture with pain in the respective body regions mentioned in the column heading (eye, neck, lower back, shoulder, upper/lower arm, wrist, and hand) is presented in this table. ^*p<0.05. ^**p<0.01.

3.5.7 Risk factors related to incorrect posture

The association between the incorrect posture and pain in different body regions was obtained by conducting chi-square test. The p-value obtained less than 0.05 is listed in Table 10. This analysis showed that the posture head and neck bent while working and shoulders and upper arms stretched forward or elevated led to pain in the entire upper part of the body. The posture trunk leaning forward or backward led to pain in lower back, shoulder, arm, wrist, and hand.

4 Discussion

The present study investigated the correlations between risk factors and the prevalence of self-rep-orted pain among computer professionals from India.

The observed 1-year prevalence of pain in eye, arm, neck, shoulder, and back among the participants was 38.2%. It was also found that the self-reported pain in the eye, neck, and back was much higher than the forearm and hand region. According to the studies conducted in Sudan, Dutch, Greece, Selangor and Kuala Lumpur, Estonian, Turkey, India, Ghana and Australia, neck, back, and shoulder pains were the most frequently reported complaints [17 –22]. The present study also showed that there was an increase in health care expenses, as 42.8% took treatment from hospitals for their health issues, while 28% reported absenteeism from work. Priyanga Ranasinghe et al. also reported an increase in medical expenses, as 22.7% had taken treatment from health care professionals for their ailments [18].

It was observed that computer professionals predominantly used desktops and laptops at work and used laptops and smartphones at home. The observed prevalence of pain in the usage of a smartphone at work was 55.56%, which was much higher than that of desktop, laptop, and tablets. It was also observed that the prevalence of pain for the usage of the laptop at home was 42.11 %, which was much higher than the other devices. This indicated that computer users tend to position their laptop in their homes incorrectly.

Previous studies confirmed that pain in upper mus-culoskeletal extremity among computer office workers was related with both physical and psychosocial risk factors [17 –22]. The present study showed that long hours of work and no habit of exercise were significantly associated with the prevalence of pain. The results also showed an association between non- neutral postures (bent head and neck, elevated/stretched shoulders, non-supported arm, and twisted trunk) and pain experienced among IT professionals in India. This finding was consistent with previous studies that reported the correlation of pain and incorrect posture of the neck, upper arm, and wrist among IT professionals in India [4, 5].

The issues faced in the workstation were prioritized and presented in Table 3. Based on the priority of the issues in workstation evaluation, the correlation between the issues and the prevalence of pain in different body regions was found in this study and presented from the Table 4 to Table 10. From the Table 4, it was inferred that not placing the monitor directly in front of the user-led to pain in the eye, neck, lower back, shoulder, lower arm, wrist, and hand. Similarly, the monitor distance being too far led to pain in the neck and shoulder. Szeto and Sham [23] also found that computer professionals working in different oblique positions (central screen position, angled left position, and angled right position) of the monitor led to mutual rotation and side flexion of the head and neck and also a significant increase in the muscle activity of the ipsilateral cervical erector spinae and contralateral upper trapezius. The reason for the incorrect placement of the monitor could be due to the usage of telephone or referring to a document while working on the computer. From Table 3, 69% of cases did not use a document holder, and 56.40% did not use a headset for the telephones. Hence, it is recommended that usage of headset and placement of a document holder next to the monitor to refer the required document would help to maintain neutral postures of the neck, back, shoulders and arm and thus ultimately reduce pain [24].

From Table 5, it was found that users not seated on height-adjustable chairs fitted on rollers experienced pain in the eye, neck, and wrist. It was also observed that the majority of IT professionals used adjustable height chairs fitted on rollers and were having lumbar support backrest.

The usage of keyboard and other pointing devices caused sustained exposure to force repetition and non-neutral postures of the upper extremity [6]. From Table 6, it was found that IT professionals using the computer workstation with no provision to adjust the position of keyboard-led to pain in the eye, upper back and shoulder which was consistent with previous studies done. From Table 7, it was examined that the input device (Keyboard and mouse) placed improperly led to pain in the wrist and hand. The experimental study done by Kotani et al. [6] sugges-ted that a reduction in non- neutral postures of the wrist was observed as the keyboard was moved away from the user and it was noted that the presence of a large pad was needed to keep the wrist from extending during the task. From Table 7, it was found that using a non-suitable type of input device led to an increase in pain in the upper arm, hand, and wrist. The pressure at the carpal tunnel and muscle fatigue for an ergonomic mouse were evaluated and found less fatiguing [8].

Shoulder pain played an essential role in the co-ordination of wrist flexors and extensors during computer mouse work [25]. The present study also confirmed that the non-adjustment of the position of the mouse led to increased pain in the wrist, upper arm, and shoulder (Table 7). It is recommended that the discomfort and fatigue for right-handed computer mouse could be reduced by placing the mouse and keyboard at the same height and a distance of 13 cm from the midpoint of the right edge of the keyboard and a little distance away along the y-direction (around 5 cm) [26].

From Table 8, it was found that the non-supportive armrest led to increased pain in the wrist and hand. From Table 9, it was found that improper placement of wrist rest and using a poor design of wrist rest (beaded) led to increased pain in the forearm. Likewise, wrist resting on sharp edges led to pain in the hand and wrist. As per the investigations done by Nag et al. [8], forearm support can considerably reduce electromyography activity of the bilateral forearm and shoulder muscles. Furthermore, gel-filled wrist rest in comparison with the bead packed wrist rest can reduce the load on the forearm muscle [8]. Another study confirmed that the forearm support could reduce shoulder muscle activity and torque and palm support can lower wrist extension and applied forces to the mousepad [27]. In the current study, there was significantly (p < .05) high discomfort level due to lack of wrist/palm rest.

The study showed that it is essential to use adj-ustable workstations to reduce pain in eyes, arms, necks, shoulders, and back. It was also found that ergonomic knowledge and training were not significantly related to the pain experienced by the users. From the present analysis, it is suggested that having only ergonomic intervention can be less effective. It was found by Feuerstein et al. that ergonomic intervention, along with job stress management, was highly effective [28].

It was also observed that the 1-year prevalence of pain among the participants was 38.2%, which was less compared to the previous studies done [2, 29]. It was also noticed that the majority of participants were provided with suitable adjustable works-tations. It was observed that despite having some ergonomic knowledge to adjust the workstation acc-ording to ergonomic principles and having an adj-ustable workstation, there was still a prevalence of pain. Previous studies suggested that the risk factors related for the growth of musculoskeletal ailments were due to psychosocial risk factors (excessive workload, time pressure, and absence of social support from colleagues and superiors) [4 , 30]. Hence, it can be suggested that because of psychosocial risk factors, the computer users were unable to adjust their workstation as per the ergonomic guidelines. The significant interventions done by various researchers to reduce pain in computer workers were mainly ergonomic training [31 –33], software to give reminders to the users of the incorrect posture adapted (surveillance system) [34, 35], exercise training [36], sit-stand workstations [37, 38], dynamic workstations to reduce sedentary work [39 –43], multi-position workstation [44], taking active breaks [45], an automated monitor [46] and wearable posture correction sensor on head and neck posture [47] to adjust the monitor position as per the seated height of users. The challenge faced by the researchers with the surveillance system was that it could only be used as a reminder and the computer users need to depend on themselves to adjust their posture to reduce myopia, backbone/neck diseases, and other health problems. Wu et al. studied the posture enhancement of users by developing and evaluating a system called ActiveErgo, which automatically adjusts the monitor height to the seated height of the user [46]. They have confirmed that this system improves the posture compared to manual configuration and helps more users significantly to fully meet ergonomics guidelines. Hence, in order to further improve occupational health of IT employees, it was suggested to use a smart workstation which could automatically adjust the position of the chair, keyboard, mouse and forearm rest based on the user’s anthropometric data and as per ergonomic guidelines to maintain a neutral posture.

The present study has several limitations, and the results must be considered based on it. The participants found the 98-item survey too long. There could be bias in reporting of complaints in the past 12 months. The effect of psychosocial risk factors was not included in the present study. Further studies might improve self-reports on work postures and evaluation of the design of workstation by conducting an experimental study using high precision instruments like electrogoniometers and 3-D motion analysis of infrared camera system to detect work postures continuously. A similar study can be done among the IT professionals in North India to validate further or compare the results.

Potential applications of this research include knowledge of the most reported upper body region pain and the investigations of the risk factors cau-sing pain. This will help the researchers, workstation designers, and computer users to carry out appropriate ergonomic interventions to improve the occupational health of IT employees.

5 Conclusion

The current risk factors for complaints of pain related to computer workstation design, bad work postures, and ergonomic awareness among Indian employees are identified in this study.

Both desktops (43%) and laptops (36%) were predominantly used at work and laptops (44%), and tablets (41%) are predominantly used at home in India.

It was observed that using computers for long hours per day led to pain in the upper part of the body. It was found that people who predominantly worked on smartphones were more prone to discomfort and pain. It was also observed that the people who did re-gular exercise had less pain in the upper part of the body.

It was ascertained that despite having well des-igned and adjustable workstations and good erg-onomic knowledge; pain was prevalent among IT employees. Therefore, in order to improve occupational health of IT employees, it was suggested to use a smart workstation which could automatically adjust the position of the chair, keyboard, mouse and forearm rest based on the user’s anthropometric data and as per ergonomic guidelines to maintain a neutral posture.

Conflict of interest

None to report.

Funding

There was no funding available to carry out this work.

References

Shikdar

, Al Kindi

. Office Ergonomics: Deficiencies in Computer Workstation Design. International Journal of Occupational Safety and Ergonomics: JOSE. 2007;13(2):215–23.

Silvian

, Maiya

ATR

, Page

. Antecedents of work-related musculoskeletal disorders in software professionals. Int J of Enterprise Network Management. 2011;4(3).

Iqbal

. Evaluation of VDT Workstation –An Ergonomic Approach. Proceedings International Conference on Ergonomics (HWWE 2009). 2009;6:320–7.

Sharan

, Ajeesh

. Correlation of ergonomic risk factors with RULA in IT professionals from India. Work. 2012;41:512–5.

Sharan

, Parijat

, Sasidharan

, Ranganathan

, Mohandoss

, Jose

. Workstyle risk factors for work related musculoskeletal symptoms among computer professionals in India. Journal of Occupational Rehabilitation. 2011;21(4):520–5.

Kotani

, Barrero

, Lee

, Dennerlein

. Effect of horizontal position of the computer keyboard on upper extremity posture and muscular load during computer work. Ergonomics. 2007;50(9):1419–32.

Lee

, Liu

. Postural and muscular responses while viewing different heights of screen. International Journal of Occupational Safety and Ergonomics. 2013;19(2):251–8.

Nag

, Pal

, Nag

, Vyas

. Influence of arm and wrist support on forearm and back muscle activity in computer keyboard operation. Applied Ergonomics. 2009;40(2):286–91.

Van Niekerk

, Louw

, Hillier

. The effectiveness of a chair intervention in the workplace to reduce musculoskeletal symptoms. A systematic review. BMC Musculoskeletal Disorders. 2012;13:145.

10.

Fostervold

, Aarås

, Lie

. Work with visual display units: Long-term health effects of high and downward line-of-sight in ordinary office environments. International Journal of Industrial Ergonomics. 2006;36(4):331–43.

11.

Cook

, Burgess-Limerick

, Papalia

. The effect of wrist rests and forearm support during keyboard and mouse use. International Journal of Industrial Ergonomics. 2004;33(5):463–72.

12.

Straker

, Burgess-Limerick

, Pollock

, Maslen

. The influence of desk and display design on posture and muscle activity variability whilst performing information technology tasks. Applied Ergonomics. 2009;40(5):852–9.

13.

Faryza

, Murad

, Anwar

. A study of work related complaints of arm, neck, and shoulder (cans) among office workers in Selangor and Kuala Lumpur. Malaysian Journal of Public Health Medicine. 2015;15(2):8–16.

14.

Sahu

, Solomon

. An evaluation of prevalence of complaints of eye, arm, neck, shoulder, and back and risk factors among IT professionals in India. Proceedings International Conference on Frontiers in Engineering, Applied Sciences and Technology (FEAST’17). 2017;228-34.

15.

Eltayeb

, Staal

, Kennes

, Lamberts

PHG

, de Bie

. Prevalence of complaints of arm, neck and shoulder among computer office workers and psychometric evaluation of a risk factor questionnaire. BMC Musculoskeletal Disorders. 2007;8:68.

16.

Kaliniene

, Ustinaviciene

, Skemiene

, Vaiciulis

, Vasilavicius

. Associations between musculoskeletal pain and work-related factors among public service sector computer workers in Kaunas County, Lithuania. BMC Musculoskeletal Disorders. 2016;17(1):1–12.

17.

Ranasinghe

, Perera

, Lamabadusuriya

, Kulatunga

, Jayawardana

, Rajapakse

, Katulanda

. Work-related complaints of arm, neck and shoulder among computer office workers in an Asian country: Prevalence and validation of a risk-factor questionnaire. BMC Musculoskeletal Disorders. 2011;12:68.

18.

Ranasinghe

, Perera

, Lamabadusuriya

, Kulatunga

, Jayawardana

, Rajapakse

, Katulanda

. Work related complaints of neck, shoulder and arm among computer office workers: a cross- sectional evaluation of prevalence and risk factors in a developing country. Environmental Health. 2011;10:70.

19.

Bekiari

, Lyrakos

, Damigos

, Mavreas

, Chanopoulos

, Dimoliatis

IDK

. A validation Study and psychometrical evaluation of the Maastricht Upper Extremity Questionnaire (MUEQ) for the Greek-speaking population. Journal of Musculoskeletal Neuronal Interactions. 2011;11(1):52–76.

20.

Oha

, Animagi

, Paasuke

, Coggon

, Merisalu

. Individual and work-related risk factors for musculoskeletal pain: a cross-sectional study among Estonian computer users. BMC Musculoskeletal Disorders. 2014;15:181.

21.

Osae

, Ben Kumah

. Ergonomic Challenges of Employees Using Computers at Work in a Tertiary Institution in Ghana. Optometry: Open Access. 2016;1:2.

22.

Chen

, O’Leary

, Johnston

. Modifiable individual and work-related factors associated with neck pain in 740 office workers: a cross-sectional study. Brazilian Journal of Physical Therapy. 2018;22(4):318–27.

23.

Szeto

GPY

, Sham

KSW

. The effects of angled positions of computer display screen on muscle activities of the neck-shoulder stabilizers. International Journal of Industrial Ergonomics. 2008;38(1):9–17.

24.

Goostrey

, Treleaven

, Johnston

. Evaluation of document location during computer use in terms of neck muscle activity and neck movement. Applied Ergonomics. 2014;45(3):767–72.

25.

Samani

, Fernández-Carnero

, Arendt-Nielsen

, Madeleine

. Interactive effects of acute experimental pain in trapezius and sored wrist extensor on the electromyography of the forearm muscles during computer work. Applied Ergonomics. 2011;42(5):735–40.

26.

Khan

A.A.

, Fatima

, Alfred

, Alam

. Risk of work related musculoskeletal disorders using computer mouse - an experimental investigation. Proceedings International Conference on Ergonomics (HWWE 2009). 2009;6:307–12.

27.

Onyebeke

, Young

, Trudeau

, Dennerlein

. Effects of forearm and palm supports on the upper extremity during computer mouse use. Applied Ergonomics. 2014;45(3):564–70.

28.

Feuerstein

, Nicholas

, Huang

, Dimberg

, Ali

, Rogers

. Job stress management and ergonomic intervention for work-related upper extremity symptoms. Applied Ergonomics. 2004;35(6):565–74.

29.

Darivemula

, Goswami

, Gupta

, Salve

, Singh

, Goswami

. Work-related neck pain among desk job workers of tertiary care hospital in New Delhi, India: Burden and determinants. Indian Journal of Community Medicine. 2016;41(1):50.

30.

Taib

MFM

, Bahn

, Yun

. The effect of psychosocial stress on muscle activity during computer work: Comparative study between desktop computer and mobile computing products. Work. 2016;54(3):543–55.

31.

Menendez

, Amick

3rd , Robertson

, Bazzani

, DeRango

, Rooney

, Moore

. A replicated field intervention study evaluating the impact of a highly adjustable chair and office ergonomics training on visual symptoms. Applied Ergonomics. 2012;43(4):639–44.

32.

Taieb-Maimon

, Cwikel

, Shapira

, Orenstein

. The effectiveness of a training method using self-modeling webcam photos for reducing musculoskeletal risk among office workers using computers. Applied Ergonomics. 2012;43(2):376–85.

33.

Mani

, Provident

, Eckel

. Evidence-based ergonomics education: Promoting risk factor awareness among office computer workers. Work. 2016;55(4):913–22.

34.

Lan Mu

, Chunhong

. Sitting Posture Surveillance System Based on Image Processing Technology. 2nd International Conference on Computer Engineering and Technology. 2010;l:692–5.

35.

Fathei

. Control Software Designation of Postural and Ergonomic Variables during Working with Computer Users. Journal of Information Technology & Software Engineering. 2015;05(03).

36.

Shariat

, Cleland

, Danaee

, Kargarfard

, Sangelaji

, Tamrin

SBM

. Effects of stretching exercise training and ergonomic modifications on musculoskeletal discomforts of office workers: a randomized controlled trial. Brazilian Journal of Physical Therapy. 2018;22(2):144–53.

37.

Karakolis

, Callaghan

. The impact of sit–stand office workstations on worker discomfort and productivity: A review. Applied Ergonomics. 2014;45(3):799–806.

38.

Lin

, Barbir

, Dennerlein

. Evaluating biomechanics of user-selected sitting and standing computer workstation. Applied Ergonomics. 2017;65:382–8.

39.

Commissaris

DACM

, Könemann

, Hiemstra-van Mastrigt

, Burford

E-M

, Botter

, Douwes

, Ellegast

. Effects of a standing and three dynamic workstations on computer task performance and cognitive function tests. Applied Ergonomics. 2014;45(6):1570–8.

40.

Alderman

, Olson

, Mattina

. Cognitive function during low-intensity walking: a test of the treadmill workstation. Journal of Physical Activity & Health. 2014;11(4):752–8.

41.

Koren

, Pišot

, Šimunič

. Active workstation allows office workers to work efficiently while sitting and exercising moderately. Applied Ergonomics. 2016;54:83–9.

42.

Schellewald

, Kleinert

, Ellegast

. Use and physiological responses of portable dynamic office workstations in an occupational setting –A field study. Applied Ergonomics. 2018;71:57–64.

43.

Groenesteijn

, Commissaris

DACM

, Van den Berg-Zwetsloot

, Hiemstra-Van Mastrigt

. Effects of dynamic workstation Oxidesk on acceptance, physical activity, mental fitness and work performance. Work. 2016;54(4):773–8.

44.

Workineh

, Yamaura

. Multi-position ergonomic computer workstation design to increase comfort of computer work. International Journal of Industrial Ergonomics. 2016;53:1–9.

45.

Waongenngarm

, Areerak

, Janwantanakul

. The effects of breaks on low back pain, discomfort, and work productivity in office workers: A systematic review of randomized and non-randomized controlled trials. Applied Ergonomics. 2018;68:230–9.

46.

, Wu

, Taele

, Wang

, Liu

, Ku

, Chen

. ActiveErgo: Automatic and Personalized Ergonomics using Self-actuating Furniture. Proceedings of the SIGCHI Conference on Human Factors in Computing Systems - CHI’18. 2018.

47.

Ailneni

, Syamala

, Kim

I-S

, Hwang

. Influence of the wearable posture correction sensor on head and neck posture: Sitting and standing workstations. Work. 2019;62(1):27–35.

Ergonomic evaluation of the risk factors causing pain in the upper part of the body among IT professionals in India

Abstract

BACKGROUND:

OBJECTIVE:

METHOD:

RESULTS:

CONCLUSION:

Keywords

1 Introduction

2 Methods

2.1 Study participants

2.2 Study instruments

2.3 Statistical methods

3.1 Demographic characteristics

3.2 Physical workstation characteristics

Table 2 Risk factors verses pain complaints Risk factors p value Gender 0.308 Daily computer usage 0.029* Duration of occupation Current position: 0.182, IT field: 0.211 Type of device at work Smartphone –0.03* Ergonomic information 0.868 Ergonomic training 0.365 Exercise 0.003** Age 0.365

3.5.3 Risk factors related to keyboard position

3.5.4 Risk factors related to the position and design of the mouse

3.5.5 Risk factors related to the design of the armrest

3.5.6 Risk factors related to the design of wrist rest

Table 8 Design of arm rest verses pain in different body regions Design of arm rest Left and right wrist and hand Left and right upper arm Non-supportive armrest 0.031* 0.321 Forearm rest height 0.431 0.060 not adjustable

4 Discussion

5 Conclusion

Conflict of interest

Funding

References

Table 8
Design of arm rest verses pain in different body regions

Design of arm rest Left and right wrist and hand Left and right upper arm

Non-supportive armrest 0.031^* 0.321

Forearm rest height 0.431 0.060

not adjustable