Frequency of musculoskeletal complaints and their associated risk factors among computer workers

1 Introduction

The world of information technology is evolving so that gadgets like computers, the internet, and cellular phones became essential parts of the life of most individuals. Although these appliances make our life easier but they pose many harmful effects on our body [1]. The working population spends a considerable part of their day on computers and now musculoskeletal symptoms are frequently seen in these population groups especially neck pain [2].

Work-related musculoskeletal ailments are predominant among numerous occupational classes like factory workers [3], truck drivers [4], hairdressers [5], allied health professionals [6], field workers [7], and computer workers [8].

Exhaustive routine, physical reactions due to monotonous work [9, 10], awkward posture [11], and continuous work without breaks are important prerequisites for Musculoskeletal disorders (MSDs) [12].

The United States Occupational Safety and Health Administration (OSHA) calculated that employers are spending $20 billion a year on worker’s compensation costs due to ergonomic traumas and disorders [9]. The direct cost of these work-related musculoskeletal disorders (WMSDs) is the money spend on the medical management of the employee. Due to the decrease in work productivity of employees, employers have to train new staff, and also need to hire new workers adds to the indirect cost of MSDs [13].

The regions that are prone to developing musculoskeletal injuries are the lower back, upper back, neck, and upper extremities [14]. Apart from MSDs, visual discomforts, eyestrains, difficulty in focusing [15], headache, tiredness, and back pain [16] are also reported by many computer users. Toomingas et al. stated that visual symptoms and musculoskeletal pain due to computer work disturbed the life of thousands of individuals each year [17].

Since the neck, shoulders, and arms are a real unit, let’s consider their risk factors collectively. Therefore, the neck, shoulder, elbow, wrist, and hands are together considered as ‘upper extremity’ [18].

MSDs affected millions of computer users in developed countries. Also in under-developed, there is a drastic rise in the use of the computer, and a consequent rise in MSDs [19, 20]. Also, risk factors linked to WMSDs were studied in developed countries but little knowledge is known with regards to developing nations [21]. Very few studies considered the intensity of pain as well as the severity of this disease to a level that it can hinder daily life activities of office workers [22]. Hence, this study tried to fill some gaps so that the domain of occupational health can be further explored for the work-related risk factors.

2 Methods

Total 396 participants were interviewed through a structured questionnaire, out of which 326 computer users responded completely from February 2020 to March 2020. Subjects were selected based on inclusion criteria determined before the start of the study. The non-probability purposive sampling technique was employed and the study design was a descriptive cross-sectional study.

Three clusters of computer workers were taken namely the banking sector, telecommunication firms, and universities. Out of these, the researcher selected one government and one private institute from each cluster. Sixty-six participants were selected from each institute who fulfilled the inclusion criteria. From the university mainly students with Computer sciences studies at bachelor’s level were selected. Structured interviews were conducted to evaluate the health status of participants regarding musculoskeletal disorders.

Interview data included sociodemographic profile such as age and gender, risk factors such as institute type and hours of exposure to the computer, along with detailed inquiry regarding musculoskeletal symptoms with individual regions’ side, and intensity of complaints. Participants were asked to rate their pain intensity from 0 (no pain) to 5 (worst possible pain) according to the numeric rating scale which was used by standardized instruments like Brief Pain Inventory (BPI) [23]. For simplification of results, pain intensity scale 1 and 2 were stratified as mild pain, 3 as moderate, and 4 and 5 as severe pain.

Weight and height were recorded by the investigator using a standard (digital) weighing scale (kept on a firm horizontal surface to the nearest 500 gm) and inches tape (nearest 1 cm.).

Subjects were considered for the study if they were aged between 18 to 50 years, gave consent to be the part of this study, and worked on the computer on e.g. administrative, graphical, and data entry tasks for at least 2 hours a day. Subjects were excluded if they had undergone any accident or surgery of anybody’s muscular system or had severe psychiatric or behavioral disorders (requiring treatment in the last 30 days). After the collection of data, it was cleaned and then stratified to address confounders like age, gender, different job sector, etc., and then analyzed. Numerical data were presented through mean and standard deviation and categorical data were presented through frequency and percentages. The Chi-square test was a statistical test that was applied on categorical data with p-value less than 0.05 was considered significant.

3 Results

Out of 326 participants, 210 were males and 116 were females, with most of them were between the ages of 15 to 23 years. Mean body mass index (BMI) was 22.17±4.33 kg/m², of which 23.23±4.18 kg/m² in men, 20.27±3.94 kg/m² in women. An almost equal number of participants belonged to both government as well as private institutes while most of them were working for more than 5 days a week (64.7%) and more than 3 hours per day (88%). Average days and years working on the computer were 5.57±0.90 days and 5.37±4.31 years. Only 16% of employees worked overtime, 75.8% (247) used the computer at home, and 23.6% did not take any break during work. After asking for musculoskeletal complaints, 55.8% (182) participants’ reported any complaint in the upper extremity, 52.1% (170) suffered visual fatigue, 49.4% (161) got irritable after work, 54.6% (178) thought that their body aches were work-related, 40.5% (132) thought that my complaints got worse after work and 30.7% (100) reported that they had more than 5 areas suffered from musculoskeletal complaints in the past year (Table 1).

The most frequent areas affected with MSDs were shoulder (45.4%, 148), neck (43.3%, 141) and upper middle back (35.6%, 116), followed by wrist(s)/hand(s) (32.8%, 107), arm(s) (31.9%, 104), lower back (31.6%, 103), lower leg(s), foot or ankle(s) (23.3%, 76), fingers/thumb(s) (18.4%, 60), thigh/knee(s) (17.2%, 56), eyes (1.8%, 6) (Fig. 1).

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Fig. 1

Frequency distribution of study subjects according to musculoskeletal complaints at different anatomical regions.

Table 2 showed that in all regions, both left and right sides were more commonly affected than the single side, after that right side of the body was more commonly affected than the left side, both in males and females. Considering the intensity, moderate pain was more common than mild and severe pain in all body areas, but in the shoulder, arm, wrists/hands, fingers/thumbs, and thighs/knees milder pain was more frequent than severe pain (Fig. 2).

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Fig. 2

Distribution of study subjects according to complaints of musculoskeletal disorders during the previous year, persisting for 7 days distributed by each anatomical area (%) w.r.t severity of WMSDs.

Cross tabulation showed that any complaint in upper extremity (p = 0.047) especially finger/thumb(s) (p = 0.049) was more common in younger age group. Any complaint in upper extremity (Past Year) (p = 0.000) specifically pain in shoulder (p =0.000), arm (p = 0.026), wrist(s)/hand(s) (p = 0.007), neck (p = 0.000), upper middle back (p = 0.000) and lower back (p = 0.005), visual fatigue (p =0.008), irritability (p = 0.000), more than 5 affected areas (p = 0.002) were more common in females than males. BMI was not related to musculoskeletal pains/complaints. Any complaints related to MSDs (p =0.000) and shoulder pain (p = 0.004) were more common in government employees (Table 3).

Working days more than 5 days (shoulder: p = 0.000, arm: p = 0.000, wrist(s)/hand(s): p = 0.005, neck: p = 0.001, thigh/knee(s): p = 0.002, lower leg(s), foot/ankle(s): p = 0.002, no of areas ≤5 areas: p = 0.013, any complaint in upper extremity: p = 0.000); working on computer more than 3 hours per day (shoulder: p = 0.010, upper middle back: p = 0.002, lower back: p = 0.007, any complaint: p = 0.003) and more than 5 years of using computer (lower back: p = 0.094) were important factors leading to musculoskeletal disorders (Table 3).

Also, the overtime work (fingers/thumb(s): p = 0.007, neck: p = 0.046, thigh/knee(s): p = 0.002, upper middle back: p = 0.035, no of areas ≤5 areas: p = 0.016); use of computer at home (shoulder: p = 0.021, arm: p = 0.011, wrist(s)/hand(s): p = 0.014, neck: p = 0.004, thigh/knee(s): p = 0.024, lower leg(s), foot/ankle(s): p = 0.023, upper middle back: p = 0.000, lower back: p = 0.002, irritability: p = 0.020, no of areas ≤5 areas: p = 0.010, any complaint in upper extremity: p = 0.000) and no break during computer work (lower back: p = 0.009) were also related with MSDs (Table 3).

This study showed that shoulder and neck region had the highest prevalence of MSDs and younger age, female gender, government institute, working more than 5 days/week, more than 3 hours per days, more than 5 years of using the computer, overtime work, use of the computer at home and no work break were significant factors leading to musculoskeletal pains.

Any complaint in the upper extremity was reported by 55.8% of participants while the visual symptoms were noted by 52.1%. Blagojević reported that 55% of computer users reported the symptoms of musculoskeletal disorders and 27.3% of people had visual symptoms [24], whereas Subas reported 71% prevalence of at least one area MSDs [25]. Also, (52.1%) 170 of respondents suffered visual fatigue, almost near to the frequency in the study done by Filon in which 64% of computer users complained of visual fatigue and it was not related to age, gender, and refractory errors [26].

In the current study musculoskeletal pains were more common in the shoulder (45.4%, 148), neck (43.3%, 141), and upper-middle back (35.6%, 116), which supported the study done by Shariat et al. in which the frequency of back, shoulder and neck pain were proved to be of peak occurrences as 60.6%, 55.0–58.6% and 55.8% respectively [11]. By considering physical factors, constant work on the computer puts a lot of stress on the cervical muscles leading to musculoskeletal pain and in the United Kingdom, the prevalence of neck pain was 17.9% [27]. Ardahan and Simsek [19] found that neck (67.85%), upper back (66.33%), lower back (59.49%), right shoulder (45.32%), and left shoulder (43.54%) were the most common areas at which computer users reported discomfort.

In Kolkata, the prevalence of musculoskeletal sym-ptoms ranged from 40% to 70% in different regions in which neck, elbow, shoulder, and low back were commonly affected with low backaches were the most common issues limiting their work routine frequently due to lack of maintaining an erect posture and were most common in female employees [11, 28]. Furthermore, a study conducted in India in 2018 showed the highest prevalence of neck pain [29].

A study conducted in Turkey also found that computer workers suffered MSDs on the right side more commonly than on the left side [30]. In this cross-sectional study among computer users, we found that most of the targeted population (55.8%) reported WMSDs complained of pain at both sides of the body followed by the right side of the body during the last year for at least a week.

Figure 2 illustrates the degree of pain experienced by computer users who participated in this study in different body regions. The degree of pain was determined using a five-point scale which is summarized into three levels i.e. mild, moderate, and severe. Pain in the neck, shoulder, upper-middle and lower back was mild to moderate in most cases while in the arm region mild pain was usually felt. In a case-control study in Tainan, it was found that, during the last 6 months, 73%, 71% and 60% of computer office workers complained of musculoskeletal symptoms in the shoulder, neck, and upper back respectively. The severity of these complaints was more for shoulder (2.9), neck (2.4), and upper back [2] areas especially by using computer use for more than 4 hours [10].

In this study, odds of the upper extremity, low back pain, and other lower extremity complaints were the same in all age groups. The same is the case with another study in which low back pain had no relationship with age but sick leaves taken due to MSDs were also not related with age as a contrast to another study in which older adults took leaves more commonly for different regions MSDs as compared to younger individuals [25].

Females experienced significantly more musculoskeletal problems but results were not statistically significant. Females more frequently reported MSDs especially in the shoulder [10], neck [11], and leg areas than males [25], same is the case with this study, in which MSDs were more common among females computer users (p = 0.000). Other studies also showed the same results [10, 31].

BMI was not related with any area complaint, unlike other studies that showed the robust link of BMI with MSDs [32, 33] and any complaint of MSDs especially shoulder pain was significantly co-related with government institute is contrary to study done by Anyfantis et al. in which type of institute was not related with MSDs [34].

In this study, there was a direct relationship between hours of using a computer with MSDs. Ardahan et al. studied the musculoskeletal health disorders among 395 computer users and found that the dose-response relationship was true between hours working on the computer and MSDs [19].

Similar results were shown in developing countries like Pakistan by Sabeen et al. where the incidence of neck pain was found to be 72%, which was directly related to using the computer for long hours, usually exceeding 5 hours per day, and decreased by taking gaps between work [35].

The current study presents that work-related factors like duration of computer use and posture were linked with different areas of musculoskeletal complaints. These factors were also responsible for the severity of these complaints, suggesting a dose-response association [11]. This study was supported by Ranasinghe, who found that muscle disorders of the upper body among IT staff were linked with work-associated factors related to the body and mind. This research showed irregular posture caused by work-related physical factors and the intensity of the symptoms of the study population proved this dose-response ratio [36].

This study showed that 52.1% (176) of the respondents suffer from visual fatigue but no relationship was shown with the duration of computer use. However, Sen et al. observed that visual fatigue was present in 58.4% to 64% of computer users and significantly increased in respondents with increasing hours of using the computer.

To examine the musculoskeletal system disorders, some ergonomic modifications can be done like training, frequent breaks, and small exercise between work [12].

5 Limitation

This study was a cross-sectional study and was performed on a relatively small number of employees. Future studies should be performed on a large sample size to get a clear picture of causal factors.

6 Conclusion

Duration of computer use was related to multiple musculoskeletal and psychosocial complaints. Employers should take action to increase their workers’ ergonomic awareness.

Conflict of interest

None to report.