Computer-usage and associated musculoskeletal discomfort in college students

Abstract

BACKGROUND:

High use of computers among college students and the resulting musculoskeletal disorders raises concerns regarding healthy usage patterns.

OBJECTIVE:

The purpose of this study is to examine college student’s computer usage and related musculoskeletal discomfort.

METHODS:

A sample of 338 college students completed a cross-sectional survey consisting of demographic questions, musculoskeletal discomfort indicators and questions regarding computer use.

RESULTS:

The sample included 232 (68.6%) females and 106 (31.3%) males. 61% students had reported discomfort during or after working using computers with greatest discomfort in the neck (68.5%) and lower back (66%). Female students were more likely than male students to report any musculoskeletal discomfort (66% vs 51%), p < .05. Sitting duration, awkward postures and length of time (more than eight hours) were significantly associated with musculoskeletal discomfort (R² = 0.24, p < .01).

CONCLUSION:

Most female college students reported musculoskeletal discomfort during or after computer use. Daily use of computer for more than eight hours, assuming awkward postures and sitting for long duration without breaks were found to be significantly related to musculoskeletal discomfort. Emphasizing good computing habits in college students to avoid musculoskeletal symptoms in the future will prevent morbidity in future workforce.

Keywords

College student computer posture ergonomics

1 Introduction

In view of the high use of computers and the resulting musculoskeletal disorders, researchers recommend prevention and education for individuals regarding ergonomics to ensure better and more neutral postures of the body while working at the computer, incorporating exercise, and requiring adequate work breaks [1, 2]. The importance of ergonomics, good posture, and good computing habits in work and daily life has been emphasized by workers using computers [3] especially in the midst of the present COVID-19 pandemic where the predominant mode of learning has been online. Musculoskeletal disorders (MSD) are soft-tissue injuries caused by sudden or sustained exposure to repetitive motion, force, vibration, and awkward positions and can affect the muscles, nerves, tendons, joints and cartilage in the upper and lower limbs, neck and lower back [1]. Causes of musculoskeletal disorders include repeated micro trauma to tissues, overload of the upper extremity, neck, shoulders and trunk, sustained awkward postures and long duration of use [2 , 4–8].

There is a significant association between computer-related MSD and work interference with the added risk factors of age and being of female gender [9]. Women suffer approximately twice as much as men from computer work-related complaints in the neck and upper extremities [5 , 11] –with suggestions that anthropometrics may cause women to work in more extreme postures or use higher relative muscle forces than men [9, 12]. Anthropometry defines the differences in physical characteristics between individuals such as a person’s size, form, and functional capacities [10]. Anthropometric differences exist between male and female skeletal system as females have a smaller skeletal system and a shorter reach distance than males on average [10]. Research has found that women had higher muscular activity in certain muscles and had the highest exertion in the neck and shoulder than men when operating a computer mouse during certain tasks [9, 12].

While computers are used in the workplace, they are an integral part of the education system, from elementary school to the university level [13, 14]. Student posture in classroom environments has been implicated as a risk factor for spinal MSD [15 –18]. Past literature that examined the evidence on school student’s posture in classroom environments, and its potential for predisposing adults to musculoskeletal conditions (particularly neck and low back pain) in their working life, found that factors like student posture, anthropometrics and furniture, and computer use, could influence the prevalence of MSD amongst pupils [15]. Some studies found that awkward postures were associated with physical discomfort [6, 19]. Another study showed that college students work on the computer for closer to 90 minutes before taking a break, while the employees worked closer to 60 minutes before taking a break. Graduate students averaged 33.7 hours on the computer weekly, similar to the hours reported by employees [2 , 20] signifying that the collective hours spent keying was an important risk factor for MSD rather than age.

Past research also documents the symptoms of upper extremity MSD in undergraduate students, with symptoms being associated with being female, and self-reported computing for more than 20 hours per week [21]. Recent research on information technology (IT) professionals’ experience and perceptions regrading WMSD with computer use and ergonomics emphasized the importance of good posture, and incorporating ergonomics in work and daily life [3].

In an exploratory study, it was found that IT professionals, long hours and several years working using computers contributed to WMSDs and employees preferred mandatory ergonomics training to be offered by their organization [3]. The study included participants from different age-groups, with several of them having MSD related to faulty posture and work-stations not being suitable to their height and length of their arms [3]. Although most of the participants tried to find solutions on their own, the study reiterates the importance of ergonomics and good computing habits.

Based on the evidence in the literature, there is a need to emphasize the importance of educating students about MSD and teaching students about healthy computing [10]. Thus, healthy computing attitudes and behaviors should be integrated for employees [1] as well as student populations, including college undergraduates and graduate students. However as there are only few studies evaluating college students and computer use, there remains a need for further research. College students represent the incoming work force and compared to the current workforce, today’s students use computers continuously from elementary school through college [4 , 16]. In most of the previous research on MSDs and computer use for college students, the personal factors of gender and age were investigated, along with the differences between undergraduate and graduate students. This study examines patterns of continuous computer use (such as the time sitting in front of a computer before a break, and stretching) as previous research has shown that there is reduced discomfort with increased break frequency.

Once the determinants and the behavior patterns of college students are explored, appropriate interventions can be implemented to help decrease the prevalence of computer-related musculoskeletal discomfort and pain. Thus, the aim of this study is to examine the college student’s computer usage and related musculoskeletal disorder risk factors. This has significance for educating students about reducing the risk factors of developing musculoskeletal disorders as they enter into the workforce.

2 Method

A non-experimental cross-sectional survey design was used for this study. The survey was completed in 2018 Fall. The survey consisted of the demographic variables of age, gender, number of hours spent using on the computer in a week, college level and incidence of MSD and behavior while using computers. The framework adopted in this study for selecting variables and organizing relationships among them is based on previous studies of work-related musculoskeletal disorders in computer users in the general population. Based on similar studies in the literature, the sample size calculation was based on the frequency with 5 % probability of error and 95 % reliability [2 , 9]. A sample size of 377 was calculated. After the study was approved by the Institutional Review, 5000 students from a large, public university on the east coast of the United States were randomly selected to include for non-response rate. Inclusion criteria was undergraduate or graduate students enrolled in the university, while exclusion criteria were incomplete questionnaires. An email invitation containing the link to the survey was sent using REDCap. To improve the response-rate, participants were sent two email reminders. A total of 362 students responded to the survey. Incomplete surveys were excluded from the analysis. The final sample consisted of 338 students.

2.1 Instrument

The survey was adapted from the Cornell musculoskeletal questionnaire [23]. The Cornell Musculoskeletal Discomfort Questionnaire (CMDQ) was developed by Dr. Alan Hedge in the Human Factors and Ergonomics Laboratory at Cornell University for the assessment of musculoskeletal symptoms in office workers based on previous studies on musculoskeletal discomfort in office workers [23]. This questionnaire is a data collection tool for assessing musculoskeletal discomfort data, and collects data on discomfort frequency, discomfort severity and work interference, and was designed solely for research purposes [23]. The CMDQ has been extensively used for the evaluation of intervention studies as well as exploratory studies across the world. The questionnaire was originally created in English, and has been translated and validated in multiple languages [8, 24]. The CMDQ was developed based on previous postural discomfort surveys and has an established high face validity and reliability [23]. The reliability of this self-report questionnaire is high, 0.986 [23, 24]. Internal consistency (Cronbach alpha) has been reported to be 0.88 [23, 24].

The questionnaire evaluates pain or discomfort frequency in 13 different parts of the body within the previous 7 days. Scores for MSD were calculated according to methods used in earlier studies [9, 23]. The survey includes demographic questions and questions related to the student’s computer use, patterns and frequency, and any associated musculoskeletal discomfort during the last week. Some of the questions are- “How many hours do you use computers in a day?” with options of “Between 30–40 hours,” “41–60 hours,” and “More than 60 hours,” “When using computer, I find myself assuming awkward, uncomfortable” or “poor” postures? The responses ranging from “Never,” “Rarely,” “Sometimes,” “Quite often.” and “Almost Always.” Responses to the questions were numerically coded for regression analysis.

2.2 Statistical analysis

The data collected through REDCap were entered into Microsoft Excel and analyzed using the Statistical Package for Social Science (SPSS, Chicago, USA) version 26. To summarize demographic variables, descriptive statistical methods such as mean, standard deviation (SD) and frequencies (count and percentage) were used as appropriate. The Chi-square test was applied to examine the effect of gender and student type (undergraduate or graduate) on the presence of musculoskeletal discomfort. A one-way ANOVA was used to examine the difference between awkward posture and MSD pain, and difference in MSD score based upon the number of hours spent on computers per day. A linear multiple regression analysis was applied to examine the effect of sitting duration, awkward postures and hours spent using the computer per day on musculoskeletal discomfort.

3 Results

The study included 338 participants with 232 (68.6%) females and 106 (31.3%) males. There were 108 (40%) graduate students (75 females, 33 males) and 230 (60%) undergraduate students (157 females, 73 males). The age of undergraduate students ranged from 18 years to 55 years and above. The age of the graduate students ranged from 21 years to 55 years and above. Table 1 provides the demographic data on the characteristics of the participants.

Table 1
Characteristics of the participants

Characteristics N (%)

Total 338

Gender

Females 232 (68.6)

Males 106 (31.3)

Age groups in years

18–20 104 (30.8)

21–25 127 (37.6)

26–30 53 (15.7)

31–35 23 (6.8)

36–40 8 (2.4)

41–45 4 (1.2)

46–50 5 (1.5)

51–55 8 (2.4)

Above 55 6 (1.8)

Student type

Undergraduate 230 (60)

   Female undergraduate 157(68.2)

   Male undergraduate 73 (31.7)

Graduate 108 (40)

   Female graduate 75 (69.4)

   Male graduate 33 (30.5)

Characteristics	N (%)
Total	338
Gender
Females	232 (68.6)
Males	106 (31.3)
Age groups in years
18–20	104 (30.8)
21–25	127 (37.6)
26–30	53 (15.7)
31–35	23 (6.8)
36–40	8 (2.4)
41–45	4 (1.2)
46–50	5 (1.5)
51–55	8 (2.4)
Above 55	6 (1.8)
Student type
Undergraduate	230 (60)
Female undergraduate	157(68.2)
Male undergraduate	73 (31.7)
Graduate	108 (40)
Female graduate	75 (69.4)
Male graduate	33 (30.5)

Approximately 61% of all students had experienced pain or discomfort in various regions of the body during or after using a computer at some time in the past seven days within the survey (Table 2). Female students were more likely than male students to report any musculoskeletal discomfort and symptoms with computer use (66% vs 51%), and this result was statistically significant, χ² (1, N = 338)=6.9, p = .009 (Table 2). Chi-square analysis addressing the relationship between musculoskeletal discomfort and student type (undergraduate or graduate student) indicated no significant relationship, χ² (1, N = 338)=.853, p = .356 (Table 2). However, a subgroup analysis of gender within the undergraduate and graduate students and musculoskeletal discomfort revealed that female undergraduate students were significantly more likely to report MSD complaints than male peers, χ² (1, N = 230)=9.15, p = .002 (Table 2).

Table 2

Musculoskeletal discomfort (MSD) in the participants

	MSD (N %)		p
	Yes	No
Musculoskeletal discomfort reported	207 (61.2)	131 (38.8)
MSD associated with gender			.009*
Female	153 (65.9)	79 (34.0)
Male	54(50.9)	52(49.0)
MSD associated with student type			.356
Undergraduate	137 (59.6)	93 (41.4)	.002*
Female	104 (66.2)	53 (33.8)
Male	33 (45.2)	40 (54.8)
Graduate	70 (64.8)	38 (35.2)	.865
Female	49 (65.3)	26 (34.7)
Male	21 (63.6)	12 (36.4)

*p<0.05.

The greatest prevalence of discomfort was reported in the neck (68.5%), lower back (66%), upper back (55%), right shoulder (43%), right wrist (40%), and left shoulder (37%). Table 3 describes the location of pain or discomfort experienced by students.

Table 3

Reported musculoskeletal discomfort in body parts (N = 338)

Body site	Almost always (n %)	Quite often (n %)	Sometimes (n %)	Never (n %)	Rarely (n %)
Neck	35 (10.4)	86 (25.5)	113 (33.5)	47 (13.9)	56 (16.6)
Right shoulder	22 (6.5)	48 (14.2)	77 (22.8)	128 (37.9)	63 (18.6)
Left shoulder	15 (4.5)	38 (11.3)	70 (20.8)	138 (41.1)	75 (22.3)
Right wrist	15 (4.5)	35 (10.4)	84 (25.0)	125 (37.2)	77 (22.9)
Upper back	27 (8.0)	82 (24.4)	77 (22.8)	87 (25.8)	64 (19.0)
Lower back	40 (11.9)	85 (25.3)	103 (30.7)	59 (17.6)	49 (14.6)

The time spent using a computer per day was divided into three groups-less than four hours, between 5–8 hours and more than 8 hours. There was a significant relationship between musculoskeletal discomfort and time spent using computer, F (2, 335)=5.358, p = .005 (Table 4). Post-hoc comparison using the Tukey HSD test indicated that there was a significant difference in reported MSD when using a computer for 4–6 hours /day (Mean = 1.66, SD = 2.008) compared to more than 8 hours/day (Mean = 2.85, SD = 2.794). However, there was no significant difference between using computers for 5–8 hours/day and the other groups. There was also a significant relationship between assuming awkward postures while using computer and reported musculoskeletal discomfort, F (2, 333)=19.451, p = .000 (see Table 4). Post –hoc comparison using the Tukey HSD indicated that there was a significant difference in MSD reported between assuming awkward postures “Almost always” (Mean = 3.82, SD = 2.50) and “Never” (Mean = 0.33, SD = 0.82), “Rarely” (Mean = 1.24, SD = 1.99) and “Sometimes” (Mean = 1.04, SD = 1.55). There was a significant difference between assuming awkward posture “Sometimes” (Mean = 1.04, SD = 1.55) and “Quite often” (Mean = 2.61, SD = 2.55) (Table 4). Reporting on taking breaks to rest and stretch while using computer, only 20.7% of the students reported that they took a break “often” while 51.8% students took a break “sometimes,” 23% of students “rarely” took a break and 4.4% “never” took a break.

Table 4

Computer- related characteristics of the participants (N = 338)

	N (%)	p
Reported hours/day on computer		.005^*
Less than 4 hours	62 (18.3)
5–8 hours	175 (51.8)
More than 8 hours	101 (29.9)
Reported assuming awkward positions while using computer		.000^*
Almost always	68 (20.1)
Quite often	137 (40.5)
Sometimes	106 (31.4)
Rarely	21 (6.2)
Never	6(1.8)
Reported taking breaks to rest/stretch while using computer
Never	15 (4.4)
Often	70 (20.7)
Rarely	78 (23.1)
Sometimes	175 (51.8)

*p < 0.05.

A multiple regression analysis was performed to explore the impact of awkward posture, sitting duration and hours spent on the computer in a day. The model was significantly related and could predict about 24% of the musculoskeletal discomfort (p = .000) (Table 5).

Table 5

Multiple regression of the musculoskeletal discomfort related to the awkward posture, sitting continuously and hours spent per day using a computer (N = 338)

	B	S.E.	β	Significance	Correlations	R	R²
Awkward posture	1.106	.137	.409	.000	.445
Sitting duration	.145	.042	.184	.001	.272
Hours spent on computer	.210	.186	.059	.261	.144
Model				.000		.491	.241

Bolded = Statistically significant.

4 Discussion

More than 60% of the participants in this study reported experiencing some musculoskeletal discomfort after using computers. This is consistent with previous studies of college students that found the prevalence to be over 50% [5 , 18]. The high prevalence of MSD in this study and previous studies may be of concern, especially given the student population. In this study, discomfort was most frequently reported in the neck, lower back, the upper back, shoulders and wrist. Previous research has reported similar body parts to be most affected [4 , 8]. About 66% of females in this sample reported MSD, consistent with past literature [5 , 9–11]. Anthropometric differences between male and female skeletal system may be responsible for this difference [10], as females have a smaller skeletal system and a shorter reach distance than males on average, thus requiring them to adopt awkward postures more often to adjust to their computer or desk or chair. For example, Wahlstrom et al. found that women had higher muscular activity in the right and left trapezius muscles and had the highest exertion in the neck and shoulder than men when operating a computer mouse during certain tasks [12].

This study found that there was no significant difference in MSD between undergraduate and graduate students. However, the subgroup analysis of gender within the undergraduate and graduate students was significant, with female undergraduate students reporting a higher prevalence of MSD. This may be a reflection of the fact that undergraduate students have been using computers for a significant portion of their lives, since childhood, and the cumulative effects of use may have contributed to the prevalence of MSD [13, 14]. This reality coupled with the anthropometric differences in females may be one of the factors for MSD. Several studies on undergraduate students MSD in the past have similar findings [15, 21].

Another finding of this study consistent with prior literature is the relationship between computing habits and musculoskeletal disorders. About 30% of the students in this study spent more than eight hours per day using a computer. These students reported MSD at a higher rate than those who spent less than four hours using the computer. Previous studies reported a positive relationship between sitting duration and hours spent using a computer and self-reported neck, and back pain [2 , 4–9]. Computer work usually results in poor sitting posture for a long period of time [19]. Sitting for long also increases the thoracic kyphotic curve and decreases the lumbar lordotic curve which, in turn, leads to the compression of intervertebral discs and pain [10]. Repetitive computer use may lead to inadequate time for complete recovery with the adverse effect of prolonged sitting accumulated over years predisposing them to MSD [9, 10]. This is especially relevant as student posture in classroom environments has been implicated as a risk factor for spinal MSD [11 , 21]. In the present study, about 40% of the students reported almost always assuming an awkward posture while using the computer, and about 20% of the students quite often assumed awkward posture. There is a positive correlation between awkward posture and MSD. This finding reiterates the importance of posture and ergonomics while using computers, as previous research has reported on the effect of cumulative hours of computer use throughout the day on the prevalence of MSD in school and college students [5 , 24]. Also, only about 50% students reported sometimes taking a break to rest or stretch in this study.

Hours spent on the computer in a day, assuming awkward postures while using computers and sitting duration together, may explain about 24% of the musculoskeletal discomfort in this study sample. These computing habits along with the anthropometric differences between female and male skeletal system may contribute to the higher prevalence of MSD in females.

These results are relevant to college student affairs and health and wellness professionals and indicate the importance of an emphasis on ergonomic interventions, especially during the current Coronavirus pandemic and the transition to online learning [25]. As the study was conducted pre-pandemic, the results could be a baseline for future studies on the impact of MSDs in the workplace. Employees who use computers for significant amounts of time and have transitioned to working at home are also in need of education on the importance of ergonomics, good posture, and good computing habits in work and daily life [3, 26]. The findings of this study represent a significant contribution to the literature as well an opportunity to create a healthy student population and current and future workforce. Given the current pandemic which necessitated transitioning in-person classes in schools and colleges to a virtual environment, findings of this study may have significant implications to prevent MSDs in college students and employees impacted by the transition to working and learning from home [25, 27]. Some of the recommendations by the National Institute for Occupational Safety and Health (NIOSH) for ergonomics and musculoskeletal disorders include avoiding the same position for long durations, making small adjustments to chairs/backrests, stretching shoulder girdles, neck, trunk, arms and wrists, avoid wrist flexion/extension for long periods of time, taking periodic breaks, hand and wrist exercises, stretching exercises, and performing these exercises for 3-4 minutes every hour [1].

The results of this study trigger further questions as to what employers are doing to ensure the health of their remote workforce. The findings although confirming the musculoskeletal discomfort existent in the literature, adds value in the present pandemic induced remote learning and work. Further research exploring and assessing post-pandemic behavior in college students, faculty and staff when using computers is warranted. Findings of this study could also form the basis for recommendations to the human resource organization of institutions that would translate into education on healthy behaviors and strategies for employees.

4.1 Limitations

This study has several limitations. Firstly, as it relied on participant self-report, memory of events that occurred in the past may not be accurate. Secondly, the sample size for this study was small, and are a sample of students at a single academic institution in the northeastern United States. Thus, generalization of the results from this study to the whole student population may be limited. Future studies may include more graduate students, with an even distribution of males and females and can explore the prevalence of MSD with a considerably larger sample size of undergraduate and graduate students and longitudinal analysis. Finally, the cross-sectional study design may not establish the causal relationship between the independent variables and MSD, as there may have been other confounding or extraneous factors such as the height, weight and arm length of the participants, affecting the results. Future studies may benefit from a prospective study design to validate the findings of this study. Further studies that analyze the impact of breaks between using computers are suggested in order to increase an understanding of their role in symptom experience and development.

5 Conclusion

This study investigated the prevalence of musculoskeletal discomfort in college students. The findings confirmed that computer related musculoskeletal discomfort is common in college students, and significantly more so in female undergraduate students. Daily use of the computer for more than eight hours, assuming awkward postures and sitting for long duration without breaks were found to be significantly related to musculoskeletal discomfort. Further studies should be performed to assess the musculoskeletal symptoms in different student populations to determine and reduce the risk factors for students as they transition to the workforce. Focusing on college students will prevent morbidity in adult workers. Workers who are already using computers for long hours recognize the importance of good posture and taking frequent breaks while using the computer to avoid musculoskeletal symptoms [3]. Recent research coupled with the findings of this study stress the importance of good posture, and incorporating ergonomics in work and daily life, especially in the pandemic era [3, 27]. As most participants in previous research seemed to be proactive and have made adequate behavior changes to incorporate ergonomics in their work and life [3], findings of this study emphasize the urgency to develop and emphasize better strategies to prevent risk factors from having an impact on students before entering the workforce. Identifying, assessing and prioritizing computer-related musculoskeletal discomfort and disorders are important for prevention of MSDs. In view of the increasing prevalence of musculoskeletal discomfort among college students and the increased use of computers at college and at home, measures must be taken to manage and control student’s computer-related MSD. Therefore, development of educational materials, guidelines and practices for student health to cultivate good computing skills are highly recommended.

Conflict of interest

None to report.

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