Musculoskeletal disorders and the affecting factors among teachers: An example from Turkey

Abstract

BACKGROUND:

Musculoskeletal disorders are important health problems due to their high incidence as well as their effects on the society and individuals.

OBJECTIVE:

The aim of this study was to determine the musculoskeletal disorders experienced by teachers, and to evaluate their relationship with certain factors causing musculoskeletal disorders.

METHODS:

The cross-sectional study was carried out on 416 teachers working in a provincial center using the face-to-face interview method.

RESULTS:

Per this 64.9% of the teachers had musculoskeletal disorders, and the pain was mostly localized in the neck region with 55.5%. The work stress scores of the teachers were found to have a positive and significant correlation with musculoskeletal disorder scores and a negative significant correlation with the satisfaction with life scores (p≤0.001). In multiple regression analysis, the time spent sitting at a desk, time spent working in a standing position, time devoted to housework, shoe preference, work stress and life satisfaction were determined as effective predictors on musculoskeletal complaints. The model that was developed explained 22.5% of the variance (R² = 22.5; p≤0.001).

CONCLUSIONS:

Due to the prevalence of musculoskeletal disorders among teachers, health-promoting actions are needed in order to raise the awareness of both administrators and teachers in improving working conditions as well as preventing musculoskeletal disorders.

Keywords

Musculoskeletal disorders teachers satisfaction stress work

1 Introduction

According to the International Commission on Occupational Health, musculoskeletal disorders (MSDs) are defined as the “diseases of the musculoskeletal system caused by working”, which are also known as the work-related upper extremity disorders or the “repetitive motion injuries” [1, 2]. It has been reported that approximately 30% of all musculoskeletal diseases are related to work due to poor working conditions [3]. Accordingly, MSD is one of the most common and important health problems in the working population [4, 5] and it is among the biggest causes of absenteeism [6]. In addition, it has been reported that labor and economic loss related to MSDs are higher compared to all other disease groups, due to the health reports, compensation costs and wage losses [6, 7].

Musculoskeletal disorders involve a wide variety of inflammatory and degenerative conditions affecting the muscles, ligaments, tendons, nerves, bones, and joints. They may develop due to a single trauma or cumulative trauma [1], and they usually have a specific pathology. There are multifactorial reasons in its etiology; however, it is basically stated that repetitive movements, inappropriate body posture or excessive use of force trigger these problems [8]. In addition to these factors, factors such as work stress, excessive workload, high-speed and repetitive monotonous work have been mentioned in the recent studies [9, 10]. MSDs are most common in the lower back, neck, hands, wrists, elbows and shoulders; and these complaints may continue as temporary or permanent conditions that cannot be treated [1]. Nonetheless, these health problems impair the quality of life of the individual, affect the job satisfaction, morale and productivity of the employee negatively, and cause workday losses [5]. It is predicted that MSDs will gradually become more common in the future, become a “new epidemic”, and constitute a health problem that needs to be investigated and resolved in the occupational diseases group [11].

In the literature, studies have emphasized that teachers are at risk in terms of MSDs [2, 12]. Teachers who have different working conditions in their work environment are faced with more physical and mental health risks compared to other occupational groups due to their certain working characteristics such as standing and sitting at a desk for a long time, as well as the increased workload demands [12, 13]. Preparing lecture notes in a fixed position, reading, evaluating, working in a standing position and performing different activities outside of the classroom are some of the physical activities of teachers while performing their duties [2]. In addition, the rapid changes in the educational environments introduced by the age of technology, the effort to meet the demands of the administrators, parents and students, and the continuous effort of the teachers may lead to increased physical and mental tension, triggering the musculoskeletal disorders [14].

In the teaching profession; there are various fields such as kindergarten, primary school, high school, vocational and special education. In general, there may be branch-specific health problems due to different age groups and different educational environments. Since providing the learning process of the individual is the main goal of education, teachers have to do the common behaviors required by the profession, even in different fields. In the literature, it is reported that the problems of MSDs among teachers are quite high due to the ergonomic problems specific to the profession. Studies show that although individuals may have incomplete recollection of their health problems, self-report is a more reliable source in identifying work-related hazards [15] because it does not qualify for clinical validation subjectively reported symptoms. In the literature, it is recommended to use a body map showing the extent and localization of pain to reduce the chance of incomplete recall of such health problems. However, it has been reported that the use of the human body diagram is a reliable method in studies conducted to determine the pain and work effect of MSDs symptoms [16]. In this study, it was aimed to evaluate the locations of musculoskeletal system disorders experienced by teachers, the severity of pain, the state of being prevented from working and some related factors.

2 Methods

2.1 Study design

This study has a cross-sectional design. The research was conducted between March and July 2019.

2.2 Population and sample of the study

The population of the study consisted of teachers employed in 6 kindergartens, 29 primary schools, 27 secondary schools, 15 high schools and 6 private schools in a provincial center in Turkey (N = 5326). First of all, the schools were listed, and each school was considered as a stratum. A total of eight schools, which consisted of two or one schools randomly selected from each stratum, were included in the study using the simple random sampling method. Accordingly, 8 different schools, including 1 kindergarten and private school, 2 primary, secondary and high schools, were included in the study. The sample of the study consisted of all teachers employed in selected schools during the spring semester of the 2018–2019 academic year (n = 742). After obtaining the required permissions, the study was conducted with the 416 (56.0%) volunteering individuals who were employed as teachers in the selected schools.

2.3 Data collection tools and data collection

The data were collected from the teachers employed in the schools included in the study using the face-to-face interview method. After the teachers were informed about the study, their verbal consent was obtained. Then, they were asked to fill in the questionnaires. The data were collected using the Descriptive Form, which was developed based on the literature review, the Cornell Musculoskeletal Discomfort Questionnaire (CMDQ), Work Stress Scale and Satisfaction with Life Scale (SWS), and International Physical Activity Questionnaire.

2.3.1 Personal information form

The Personal Information Form was developed by the researchers by reviewing the relevant literature. This form contained questions related to the sociodemographic (age, gender, marital status, height, weight, chronic disease, number of children, time devoted to housework, shoe preference, etc.) and professional (years of working, weekly working hours, duration of working in standing position, time spent for lesson preparation) characteristics.

2.3.2 Cornell Musculoskeletal Discomfort Questionnaire (CMDQ)

The CMDQ developed by Hedge et al. measures the musculoskeletal disorders experienced by employees. The CMDQ is a measurement tool that displays 22 body regions on a diagram and questions the location, severity, and disability of the pain felt during the previous week. Body diagram extremities on the map, has been categorized as right and left. In the rows of this questionnaire, there are pictures of the body parts that point to the diagram, and in the columns there are the frequency, severity and effect of the disorders on the working power. Participants score the severity of the pain experienced in the body parts shown in the questionnaire and the relevance of the pain to the job itself. The scores to be obtained from the scale range between 0 and 90 for the discomfort in each region, and the total CMDQ score ranges between 0 and 1980. High score indicates the increased risk of MSD. The Turkish validity and reliability of the questionnaire developed by Cornell University was published by Erdinç et al. in 2011. The Turkish version of the CMDQ had a Kappa coefficient between 0.62 and 0.92, and the Cronbach’s Alpha score of the questionnaire was 0.88 [17]. In the present study, the Cronbach’s Alpha value was 0.84.

2.3.3 Work Stress Scale

The Work Stress Scale was developed by Haynes with the aim of determining the level of work stress in employees. Its Turkish validity and reliability study was conducted by Aktaş [18]. The scale consists of 10 items, and the maximum score to be obtained from the scale is 30. A score below 12 indicates that the individual is able to cope with the pressure and problems at work effectively; a score between 12 and 30 indicates that the individual has symptoms of physical and mental stress; and a score above 30 indicates that the level of work stress individual experiences is dangerously/severely high.

2.3.4 Satisfaction with Life Scale (SWLS)

The SWLS consists of 5 items in a single-factor model and was developed by Diener et al. in 1985. Its Turkish validity and reliability study was conducted by Dağlı and Baysal in 2016 [19]. It is a 5-point Likert-type scale. High score to be obtained from the scale indicates higher level of satisfaction with life.

2.3.5 International physical activity questionnaire

The International Physical Activity Questionnaire was developed by Craig et al. in 2003 in order to determine the physical activity levels of participants between 15 and 65 years of age. The questionnaire was tested for reliability and validity in Turkish by Öztürk in 2005. All activities are assessed based on the criteria that each activity is performed for a minimum of 10 minutes at a single time. The score is obtained as “MET minutes/week” by multiplying the minute, day and MET values. Physical activity levels are classified as physically inactive (3000 METmin/week) [20].

2.4 Data analysis

The data were analyzed on SPSS (Statistical Package for Social Sciences) 21.0 software. Descriptive statistical methods such as frequency, percentage, mean, SD, and the Kolmogorov–Smirnov distribution test for normal distribution were employed during the data analysis. Since the P (statistical significance) value obtained as a result of the Kolmogorov–Smirnov test analysis was greater than 0.05, it was determined that the data conformed to the normal distribution and parametric tests were used. In comparison of numerical data, difference between two groups t-test, one-way analysis of variance (ANOVA) between more than two independent groups was used. The relationship between the dependent and independent variables of the study was tested with Pearson correlation, and the effect was tested with regression analysis. In the study, multiple regression analysis was performed by correlating the CMDQ total score, which is the dependent variable, with some independent variables (work stress score, life satisfaction score, time spent on education at the desk, time allocated to housework and shoe preference). The results were evaluated at a 95% confidence interval and P < 0.05 significance level.

2.5 Ethical permission

Written permission was obtained from Namık Kemal University Medical Faculty Non-Invasive Clinical Research Ethics Committee (Date: 28 February 2019; Issue: 29.06.01.06), and the institutions where the study was conducted. The purpose of the study was explained to the participants. Written and verbal consent was obtained from the participants.

3 Results

The mean age of the teachers who participated in the study was 40.4±9.06 years, and 62.7% were female. The mean years of working was determined as 16.67±9.28 (years), mean weekly working hours was 29.95±10.87 hours/week, mean time spent working in standing position per day was 617.58±530.10 min/day, and the mean time spent sitting at the desk was 177.70±194.35 min/day. The mean score obtained by the teachers from CMDQ was 135.79±209.26; the mean score obtained from the work stress was 31.15±5.45, and the total mean score of satisfaction with life was 16.88±3.96 (Table 1).

Table 1
Some of the teachers’ working characteristics and total scale scores

Characteristics Mean±SD Median (min.–maks.)

Age 40.49±9.06 40 (22–65)

Working year 16.67±9.28 16 (1–40)

Working hours per week 29.95±10.87 30 (12–50)

Standing time (minutes/day) 617.58±530.10 480 (30–900)

Time spent at the desk for training (minutes / day) 177.70±194.35 120 (0–640)

Internet usage time (minutes/day) 146.37±148.88 120 (0–1200)

Time devoted to housework (minutes/day) 123.50±95.29 120 (0–420)

CMDQ^* 135.79±209.26 130 (0–900)

Work Stress Scale 31.15±5.45 31 (14–46)

Satisfaction with Life Scale 16.88±3.96 17 (7–25)

International Physical Activity Questionnaire (MET-minutes/week) 1618,38±2700 396 (221–2010)

Characteristics	Mean±SD	Median (min.–maks.)
Age	40.49±9.06	40 (22–65)
Working year	16.67±9.28	16 (1–40)
Working hours per week	29.95±10.87	30 (12–50)
Standing time (minutes/day)	617.58±530.10	480 (30–900)
Time spent at the desk for training (minutes / day)	177.70±194.35	120 (0–640)
Internet usage time (minutes/day)	146.37±148.88	120 (0–1200)
Time devoted to housework (minutes/day)	123.50±95.29	120 (0–420)
CMDQ^*	135.79±209.26	130 (0–900)
Work Stress Scale	31.15±5.45	31 (14–46)
Satisfaction with Life Scale	16.88±3.96	17 (7–25)
International Physical Activity Questionnaire (MET-minutes/week)	1618,38±2700	396 (221–2010)

^*CMDQ: Cornell Musculoskeletal Discomfort Questionnaire.

It was found that 64.9% of the participants experienced discomfort in some part of their bodies within the last week, and the parts where they experienced the most discomfort were the neck (55.5%), back (53.4%) and lower back (47.6%). The body areas with the least discomfort were the left elbow (6.5%) and the left forearm (8.7%). In addition, it was determined that the level of severe pain was mostly experienced in the right forearm (11.5%) as a result of the discomfort, and this pain strongly prevented 11.8% of the teachers from doing their job depending on the severity. It was reported that the pain was moderate in 22.6% of the patients with neck pain, and the pain mildly prevented 18.3% of the teachers from performing their activities (Table 2).

Table 2

MSDs according to the Teachers’ CMDQ

Body	Frequency of MSDs over the past week											Severity						Situation prevented from
territories																	doing business
		No		1-2 times a week		3-4 times a week		Everyday,once		Everyday, many times		Light		Mild		Severe		Did not hinder		It was a small obstacle		It was a big obstacle
		n	%	n	%	n	%	n	%	n	%	n	%	n	%	n	%	n	%	n	%	n	%
Neck		185	44.5	108	26.0	56	13.5	15	3.6	52	12.5	123	29.6	94	22.6	17	4.1	137	32.9	76	18.3	11	2.6
Shoulder	Right	266	63.9	77	17.5	26	6.2	16	3.8	35	8.4	78	18.8	56	13.5	13	3.1	88	21.2	49	11.8	5	1.2
	Left	279	67.0	61	14.7	26	6.2	17	4.1	33	7.9	68	16.3	56	13.5	11	2.6	68	16.3	56	13.5	11	2.6
Back		194	46.6	94	22.6	54	13.0	33	7.9	41	9.9	99	23.8	107	25.7	12	2.9	132	31.7	69	16.4	6	1.4
Upper arm	Right	359	86.3	27	6.5	10	2.4	8	1.9	12	2.9	35	8.4	20	4.8	3	0.7	41	9.9	15	3.6	2	0.5
	Left	367	88.2	25	6.0	7	1.7	8	1.9	9	2.2	29	7.0	18	4.3	2	0.5	35	8.4	14	3.4	1	0.2
Waist		218	52.4	84	20.2	52	12.5	27	6.5	35	8.4	96	23.1	90	21.6	9	2.2	113	27.2	66	15.9	11	2.2
Forearm	Right	300	72.1	55	13.2	31	7.4	20	4.8	16	3.8	31	2.5	17	4.1	48	11.5	55	13.2	16	3.8	45	11.8
	Left	380	91.3	25	6.0	5	1.2	5	1.2	3	0.7	27	6.5	11	2.6	38	9.1	27	6.5	12	2.9	39	9.4
Elbow	Right	383	88.1	20	4.8	4	1.0	4	1.0	5	1.2	24	5.8	10	2.4	2	0.5	26	6.3	10	2.4	36	8.7
	Left	389	93.5	18	4.3	3	0.7	3	0.7	3	0.7	22	5.3	8	1.9	1	0.2	23	5.5	9	2.2	32	7.7
Wrist	Right	345	82.9	40	9.6	14	3.4	5	1.2	12	2.9	44	10.6	25	6.0	4	1.0	47	11.3	19	4.6	4	1.0
	Left	368	88.5	27	6.5	8	1.9	4	1.0	9	2.2	31	7.5	18	4.3	3	0.7	34	8.2	15	3.6	2	0.5
Hip		350	84.1	31	7.5	14	3.4	6	1.4	15	3.6	36	8.7	28	6.7	4	1.0	45	10.8	19	4.6	3	0.7
Upper leg	Right	354	85.1	36	8.7	11	2.6	5	1.2	10	2.4	29	7.0	32	7.7	3	0.7	43	10.3	17	4.1	2	0.5
	Left	365	87.7	29	7.0	11	2.6	2	0.5	9	2.2	27	6.5	24	5.8	3	07	36	8.7	15	3.6	1	0.2
Knee	Right	312	78.0	58	13.9	21	5.0	4	1.0	21	5.0	60	14.4	37	8.9	10	2.4	74	17.8	27	6.5	3	0.7
	Left	323	77.6	50	12.0	18	4.3	5	1.2	20	4.8	50	12.0	37	8.9	9	2.2	63	15.1	28	6.7	3	0.7
Lower leg	Right	336	80.8	41	9.9	17	4.1	8	1.9	14	3.4	43	10.3	31	7.5	5	1.2	50	12.0	27	6.5	1	0.2
	Left	343	82.5	37	8.9	15	3.6	6	1.4	15	3.6	36	8.7	31	7.5	5	1.2	42	10.1	27	6.5	2	0.5
Foot	Right	387	69.0	51	12.3	34	8.2	18	8.2	26	6.2	65	15.6	56	13.5	11	2.6	83	20.0	46	11.1	2	0.5
	Left	273	65.6	55	13.2	35	8.4	23	5.5	30	7.2	67	16.1	60	14.4	16	3.8	86	20.7	50	12.0	6	1.4

Mean CMDQ scores of the teachers were found to have a statistically significant difference when compared with gender, shoe preference and time devoted to housework outside of work (p < 0.05). Nonetheless, no significant difference was found between the mean CMDQ scores of teachers and their marital status, age groups, physical activity levels, body mass index and weekly working hours (Table 3).

Table 3

Distribution of mean scale scores according to some characteristics of teachers (n = 416)

Characteristics	CMDQ M±SD	Statistics
		t / F	P
Gender
Women	151.62±202.77	2.009	0.035
Male	109.14±217.84
Marital status
Married	138.28±213.07	–0.083	0.934
Single	140.46±209.18
Age
22–31 years	130.85±175.22	2.051	0.106
32–41 years	156.86±225.76
42–51 years	138.61±229.63
52 years and ↑	117.30±123.62
Working hours per week
Under 25 hours	134.97±193.88	0.112	0.911
Over 25 hours	137.40±217.07
Physical activity level
Physically inactive	132.96±202.63	0.207	0.813
Low physical activity	142.79±220.41
Adequate physical activity	124.10±188.25
Body mass index
Weak (< 18.4)	260.55±215.23	2.093	0.125
Normal (18.5–24.9)	146.43±215.56
Overweight (25–29.9)	114.60±194.81
Obese (30 >)	146.52±211.46
Choice of shoes
Comfortable, orthopedic, sports shoes	121.71±214.15	–3.688	0.020
Chunky sole / Heeled shoes	172.88±202.24
Time devoted to housework (day)
0–60 minutes	87.25±174.05	6.934	0.001
61–120 minutes	162.32±229.11
121 minutes and ↑	168.11±216.43

M: Mean, SD: Standard Deviation.

In the correlation analysis on the relationship between the mean CMDQ scores of the teachers and work stress levels, there was a moderately significant and positive correlation (r = 0.453, p 0.000). In addition, there was a moderate and negative correlation between the scores obtained from CMDQ and Satisfaction with Life Scale (r = –0.350, p 0.000). It was determined that as the work stress level of the participants increased, the symptoms of MSD increased; and when their level of satisfaction with life decreased, the symptoms of MSD increased (Table 4).

Table 4

The relationship between teachers’ total scale mean scores

	Work Stress Scale	Satisfaction with Life Scale
CMDQ	^*r = 0.453	r = –0.350
p = 0.000	p = 0.000

^*r, Pearson correlation.

A multiple regression analysis was performed by correlating the independent variables with the total CMDQ score, which was the dependent variable in the study (Table 5). The model, which explained the MSDs of the teachers (Model R = 0.486; R = 0.236; Adjusted R² = 0.225; F = 20.938), was found to be significant. In the model; the work stress score (β= 0.335, p≤0.001), the satisfaction with life score (β= –0.222, p≤0.001), the time spent sitting at a desk (β= –0.117, p≤0.05), the time devoted to housework (β= –0.181, p≤0.001), and shoe preference (β= –0.062, p≤0.05) were identified as the effective predictors. The model explained 23.6% of the variance (Table 5).

Table5

Regression models of effective variables on MSDs levels of teachers

Model	B	SE	Standard β	t	p
Constant	39.295	72.72	–	3.540	< 0.001
Work Stress Score	12.827	1.69	0.335	7.548	< 0.001
Life satisfaction score	–11.697	2.32	–0.222	–5.024	< 0.001
Time spent at the desk	–49.128	18.52	–0.117	–2.651	0.008
Time spent on housework	–78.383	18.87	–0.181	–4.152	< 0.001
Time for spent on the Internet	–38.460	20.35	–0.284	–1.889	0.060
Choice of shoes	–39.097	18.58	–0.092	–2.104	0.036

Note: Model R = 0.486; R = 0.236; Adjusted R² = 0.225; F = 20.938; Dependent variable: CMDQ, Independent variables: Work Stress Score, Life satisfaction score, Time spent for training at the desk (“0” More than 4 hours, “1” less than 4 hours), Time spent on housework (“0” More than 2 hour, “1” less than 2 hour, Choice of shoes (“0” heels, “1” comfortable, orthopedic shoes). Abbreviation: CMDQ, Cornell Musculoskeletal Discomfort Questionnaire.

4 Discussion

Musculoskeletal disorders have a minimal impact on mortality; however, they are among the major causes of pain and disability in the society. The most noteworthy finding that was also obtained in the present study was that 64.9% of the teachers experienced MSDs in any part of their body within the last week. According to the previous studies conducted in many countries on the occupational risk factors of MSD in teachers, it is observed that its prevalence varies between 30–88.9% [2 , 22]. In the studies conducted with teachers, the prevalence of MSD was reported as 30% in Brazil [2], 40.1% and 61.7% in two different studies in Malaysia [10, 12], 53.5% in India [23], 55.9% in Turkey [21], 59.2% in Saudi Arabia [24], 66.7% in Estonia [25], 69.3% in Hong Kong [26], 85.5% in Taiwan and 88.9% in Pakistan [1]. The results indicated that the prevalence of MSD was higher in teachers, and the problems should not be ignored.

Similar to other studies, gender was found to be associated with MSD in the present study [3, 21]. In a study conducted by Alias et al. on female teachers, the prevalence of MSD was found to be 2.9 times higher compared to the male teachers [12]. According to the literature, the differences between the genders in terms of MSD are caused by biological factors, everyday lives and expectations. In addition to the differences in exposure, the fact that women’s response to the disease is different, and they present with more severe and a greater number of symptoms also had an effect. It is believed that the female participants, who reported a greater number of complaints, had to devote more time to chores such as housework and child care due to their traditional gender roles [27], and the conflicts between the work and the family were therefore effective [12]. Similarly, a significant relationship was found between the time devoted to the housework and the score obtained from CMDQ in the present study. The amount of time allocated to housework was higher in female teachers compared to the male teachers. Moreover, a significant relationship was found between MSD and the preference for high heels in the present study. Darwish and Zuhair [8] reported that there was a strong relationship between MSD and the female teachers who wore very high heels. This finding was explained with the fact that the impairment of walking and posture in the entire body caused severe load on the muscles and joints [8]. Looking at the results in general, we believe that the factors such as the more time devoted to housework and greater preference for high heels in the female participants compared to the male participants contributed to the prediction of the causes of MSDs.

In the present study, no significant relationship was found between MSD and the other sociodemographic characteristics such as the age, marital status, weekly working hours, exercising habits and the body mass index. There are similar findings in the literature [8]. Nonetheless, there are studies, which determined a significant relationship between MSDs and age, marital status, exercising habits and body mass index [10 , 24]. In these studies, the reason for the relationship between MSDs and age was explained with physical degeneration, reduced tissue healing and thinning of joint cartilage at advanced ages [28]. In the present study, there was no significant relationship in terms of age, and we believe that this might be due to the sample of the study which consisted of young and middle age groups. In the previous studies, MSDs were reported to be more common in individuals who did not exercise regularly [10, 11]. Although there was no significant difference between those who exercised and those who did not exercise in this study, it can be said that MSDs were experienced less in teachers who exercised regularly due to the lower average CMDQ score. In the present study, the fact that the prevalence of MSD was high among the teachers, and that almost all of the participants did not exercise regularly could have affected the results. We are of the opinion that studies with different variables in large sample groups are needed for investigating the difference between other variables and MSD.

Similar to the other studies, it was found in the present study that the pain in the neck, lower back and shoulders had a higher prevalence among the MSDs. Among the primary school teachers employed in the Central Durban region, the prevalence of shoulder pain was 80.4%, and the prevalence of lower back pain was 68.0% [29]. It was reported that the prevalence of neck pain was 52.2% within the last 12 months among the teachers in Malaysia [26], and neck pain was the most common pain among the female teachers in Switzerland with 44.0% [30]. Due to their profession, teachers perform activities that require sitting, standing up, working on the computer and sitting behind a desk for a long time. As a matter of fact, a significant correlation was observed between the time spent sitting at a desk and the score obtained from CMDQ in the present study. In a study conducted on desk workers, back pain was detected with rate of 63.0%, and neck pain with 54.3% [3]. It was also demonstrated in the literature that these activities increased risk of lower back pain in teachers [31]. These activities also cause posture deterioration. In this context, increasing the awareness of teachers on this matter will contribute to the protection of their health.

According to the literature, MSDs constitute the group of diseases that cause the highest loss of working days in employees [3]. In the present study, the part of the body where the teachers experienced discomfort that would prevent them from working was found to be the right forearm. The prevalence of pain in the right forearm was lower compared to the pain in the neck; however, it caused greater loss of working days. This may be due to the educational activities of the teachers such as preparing lecture notes and reading. In addition, the increased use of developing technology in recent years such as the use of smartphones could be indicated as the cause of the pain in the arms, wrists and neck [32]. There are also different studies emphasizing that teachers are particularly vulnerable due to these professional activities [1 , 29]. In one study, it was reported that the teachers experienced the discomfort of neck pain, and that 3.5% of the teachers with neck pain and 4.3% of the teachers with shoulder pain changed their jobs due to this reason [28]. With the use of hand tools in the literature, it has been determined by an experimental study that there are regional discomforts such as pain and muscle fatigue in the wrist and upper arm extremities [33]. Studies with larger sample groups are needed to determine the causes of musculoskeletal disorders in teachers.

One of the most important results of this study was the significant correlation between MSD found in teachers and high levels of work stress. In recent studies, it has been stated that stress developing due to physical and psychosocial risks in the workplace causes more frequent MSDs in employees [9, 10]. In the present study, it was found that the work stress levels of the teachers were above 30, which indicated that the individuals had dangerous/high level of work stress. The findings of the study are consistent with the findings of other studies. The MSDs are more common in teachers with high levels of work stress and low levels of satisfaction with life. In a study conducted by Malik and Bjorkqvist on academic instructors in Finland and Pakistan, both MSDs and mental disorders were found to have a clear correlation with occupational stress in both countries. Therefore, it was reported that occupational stress was a risk factor for the mental and musculoskeletal health regardless of the country’s level of development [9]. In another study, the teachers, who reported anxiety, stress and depression, were found to experience more MSDs. It has been stated that stress, anxiety and depression cause an increase in allergic substances in the muscles by changing blood flow and oxygen supply, as well as increasing the risk of muscle tension and pain. It is believed that the work stress caused by the working conditions, and the decreased level of hopelessness increase the risk of experiencing pain. In addition, it is emphasized that the stress experienced by teachers would affect their school performance, and suitable working conditions should be provided urgently in order to improve the education processes of future generations [8].

4.1 Strengths and Limitations of the study

Since the results of the study are based on the statements of individuals, the inability to detect a strong causality can be said as a limitation of the study. However, due to the face-to-face application of the study and the use of the body parts diagram in the questionnaire used in the study, the high tendency of individuals to remember the problems they experienced were considered as the strengths of the study. Moreover, the study will contribute to the literature in terms of being the first study examining the MSDs problems of teachers in a province in Turkey, as well as determining the risks of MSDs and guiding future studies.

5 Conclusion

It was found that MSDs were common problems experienced by teachers and negatively affected satisfaction with life, and were correlated with gender, working conditions and work stress levels. Unlike the other studies, particularly the time spent sitting at a desk, the time devoted to housework, shoe preference, work stress and satisfaction with life were determined as significant predictors of MSDs in the present study. Nonetheless, further studies with larger study groups are needed to investigate other potential effects for drawing definitive conclusions regarding the causative correlations of MSDs with other factors. The impact of increased stress on education should certainly not be underestimated. There is a need for further studies on distant education carried out by constant sitting at a desk especially due to the COVID-19 pandemic in terms of its effects on MSDs in teachers.

There is a need for protecting the health of teachers, who prepare the future generations, in order to maintain effective and continuous educational activities. Accordingly, their problems should be identified, their working characteristics should be reviewed, and necessary measures should be taken. It is important to understand the relationship between MSDs and their causes, which are demonstrated in the present study. In addition, our study will assist school administrators in organizing, planning or implementing preventive intervention programs for reducing the risk of MSDs. Moreover, the present study will raise teachers’ awareness regarding MSDs, who work in the Ministry of National Education. In this context, the study will contribute to reviewing the working conditions of teachers, the preparation of instructions for appropriate ergonomic movements, and the modeling of health-promoting behaviors in order to reduce MSDs.

Footnotes

Acknowledgments

The authors would like to thank all participants for their cooperation.

Conflict of interest

The authors declare that there are no conflicts of interest.

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