Assessment of musculoskeletal disorders among employees working office workplaces in the manufacturing sector

Abstract

BACKGROUND:

The number of studies investigating the relationship between office employees and the development of musculoskeletal disorders (MSDs) is limited. Only a few focused on assessing workplace ergonomics of office employees.

OBJECTIVE:

This study aims to investigate the risk of MSDs and associated factors in the office workplaces of a large-size manufacturing company.

METHODS:

Data were gathered from 208 office employees from a manufacturing company via Rapid Office Strain Assessment (ROSA) and Cornell questionnaire. The collected data were analyzed to examine the relationship between ergonomic risk levels and MSDs reported by the office staff.

RESULTS:

The mean ROSA final score is 3.52 (std. dev. = 0.71), chair section is 3.30, monitor and telephone section is 2.18, and mouse and keyboard section is 2.69. Thirty-nine of 208 (18.8%) office workplaces are at risk. The most important factor to raise the risk level is found to be the height and depth of the chair. The Cornell questionnaire results highlight that the highest discomfort severity is related to the neck (32.26%), lower back (23.23%) and upper back (22.26%). The discomforts in the neck (r = 0.362), upper back (r = 0.404) and lower back (r = 0.368) are moderately and positively correlated according to the final ROSA score. The results indicate that the highest risked departments are Accounting, Sub Industry, Production Planning, and Manufacturing Management.

CONCLUSION:

The parameters associated with the chair section should be considered a priority for reducing and eliminating MSDs among office employees.

Keywords

Office employee musculoskeletal disorder rapid office strain assessment cornell questionnaire

1 Introduction

Office workplaces are the areas where people work long hours and interact with much office furniture. Offices typically consist of computers, phones, desks and chairs. In order to ensure comfort and to increase the productivity of employees, it is of great importance for any type of workstation to be ergonomically designed [1]. Office workers often suffer from health problems associated with musculoskeletal disorders (MSDs) [2]. Inadvertently exposed wrong postures and improper body movements during long work hours spent in the office can cause temporary or permanent MSDs.

MSDs refer to a gamut of inflammatory and degenerative disorders initiated or aggravated largely by the performance of work or associated work settings [3]. MSD symptoms especially result from simple body movements such as bending, straightening, holding, gripping, twisting and stretching. These movements are not harmful when performed in everyday life [4]. Inappropriate sitting position, fast-paced work, force application requirements, static and awkward postures, and highly repetitive movements make those movements harmful to health. Work behaviour of this kind can increase the risks of neck, shoulder and lower back problems [2]. Several reviews have indicated a possible causal relationship between office work and musculoskeletal complaints. Associations between computer work and MSDs have been demonstrated in several studies with reported 12-month prevalence rates of MSDs in the neck, back, and upper extremities of 55–69%, 31–54%, and 15–52%, respectively [5]. MSD is the major cause of pain, disability, absenteeism, reduced productivity, and higher financial costs among employees.

Several studies have discussed MSDs risk factors among employees both in manufacturing (e.g. metal, wooden, furniture) and service (health, university, communication) working environments. Also, some recent studies focused on the manufacturing industry. The study by Spinelli et al. [6] sampled six representative work sites in Northern and Central Italy in order to assess the risk for developing musculoskeletal disease due to poor work posture among the operators engaged in semi-mechanized post debarking operations in wooden post-production. Cheţa et al. [7] evaluated the ergonomic conditions of task-based motor-manual tree falling and processing operations in flatland poplar forests by the means of workload, exposure to noise, and risk of MSDs. The risk of MSDs was evaluated using the concepts and procedures of the OWAS, indicating a high postural risk index, which can cause MSDs. Kaka et al. [3] resulted that although the lower back complaints (66.7%) were the overall and lower body quadrant’s most commonly reported MSDs among the butchers surveyed, wrist/hand complaints were the leading upper quadrant’s (45.1%) most commonly reported MSDs among 102 butchers surveyed in Nigeria. A cross-sectional study [8] was performed among 862 carpet weavers in seven towns about workhouse location in urban or rural regions. According to the results of the study, it was concluded that occupational factors were associated with the number of MSDs developing among carpet weavers. In the study conducted by Gönen et al. [9], MSDs of assembly line employees of a transformer producer were analysed by using the questionnaire study inspired by Cornell questionnaire, REBA and OWAS. As a result of the analysis, the back, waist, feet, neck, right upper arm and shoulders were identified as the risky body regions and an adjustable assembly table was designed to reduce these risks.

Office employees perform various activities, such as typing, writing and reading, that can be linked with prolonged static and awkward postures, repetitive movements and high mental workloads [10]. There are various kinds of methods to determine the risk of MSDs. Observation methods are the most common approach to evaluating physical workload at work. As one of simpler observation techniques, Rapid Office Strain Assessment (ROSA) is the best and widely used method designed to quantify exposure to risk factors in office workplaces. This technique was developed by Sonne et al. [11] to determine the level of MSD risk. ROSA allows to quickly quantify risk factors related to computer workstation considering workplace posture and equipment assessment [12]. In this method, the interaction between users and equipment (such as a chair, monitor, telephone, keyboard and mouse) used in offices are examined, thus a risk score is determined. ROSA examines the improper postures exposed by workers while using commonly-used office equipment and the exposure time to these postures. It is one of the most detailed and comprehensive risk assessment methods in office ergonomics.

Many studies have focused on evaluating the ergonomic risks of the office employees using solely the ROSA method or observation method (e.g. Cornell questionnaire), rarely both, in offices of a university [2 , 13–16], medical science of a university [10 , 17–21], hospital [22 –24], insurance company [25, 26], bank [27], communication centre (e.g. call centre) [28 –30] and other service organizations [12 , 31–34]. A few studies [10 , 35–38] have performed the cross-cultural adaptation of the ROSA method into a country version. As one of the essential studies published in recent years, Özkan and Kahya [16] investigated ergonomic risk factors in a university’s 92 offices through ROSA method and Cornell questionnaire. The results indicate significant relationships between office risk levels that are related to intense use of a monitor, keyboard, mouse and telephone and discomforts associated with neck, shoulder, and upper back. Haghshenas et al. [30] investigated the relationship between MSDs with the mental workload and occupational fatigue among office staff of a communication service. According to the results of the Nordic questionnaire, the highest pain was observed in the neck (65.94%) during the last year. Rodrigues et al. [12] compared the ergonomic, physical, and psychosocial factors in computer office workers. The chair height and armrest sections from ROSA showed higher mean values in workers. In the last recent research [10], the findings highlighted that the highest prevalence rate of MSDs within the last 12 months and the highest pain/discomfort severity were related to the participants’ necks. The pain/discomfort severity in the shoulders, elbows, wrists/hands, thighs and ankles/feet were correlated to the final ROSA score.

The aim of this study is to investigate MSDs and associated factors among office employees. Taking into consideration a review of the current literature, this research differed from previous studies in several essential ways. First, this study is a cross-sectional study to investigate MSDs and associated factors among the office workplaces of a large-sized company from a manufacturing sector using both ROSA method and Cornell questionnaire. Data were gathered from 208 employees in the offices of 14 departments. Employees’ work features may vary from one to another department in the companies of the manufacturing sector. The current study also is first attempt to shed some lights of the office conditions among departments.

2 Method

2.1 Subjects

This study was conducted in a large-sized plant manufacturing precision metal parts. The company was founded in 1985 and consists of one administrative, 5 workshops, one product testing and support buildings. About 1,300 blue-collar workers and 900 white-collar employees work in different departments. The design, product development, component and module production, assembly of parts and production tests are performed according to international standards in the company.

The study involved 208 of 416 (∼50%sample size) (168 male and 40 female) office employees working in the offices of 14 management departments. The participants were selected based on simple random sampling. They participated in this study voluntarily. A single questionnaire including demographic information (department, age, job tenure and gender of the employee), ROSA form and Cornell questionnaire (for sedentary employees) was designed to collect data.

2.2 Cornell musculoskeletal discomfort questionnaire

There are various kinds of questionnaires to determine the MSDs experienced by office employees. The Cornell questionnaire is the most common questionnaire used to assess the level of pain among office employees in response. The Cornell questionnaire is a data collection tool developed in the Human Factors and Ergonomics Laboratory at Cornell University for the assessment of musculoskeletal symptoms among the English-speaking workforce [39]. This method is not only limited to the office environment but can also be applied to other working environments.

The Cornell questionnaire involves self-rating of the frequency, severity and work interference of the MSD on three scales across 20 body parts [40]. This questionnaire is a well-designed tool for data collection. There are 57 items containing a body map diagram and questions about the prevalence of musculoskeletal ache, pain or discomfort in 20 regions of the body during the previous work week.

The Cornell questionnaire examines different regions of the body weekly by frequency, discomfort and interference with the ability to work. The results of the questionnaire are collected and a discomfort score is calculated with the aid of results [39].

On the frequency scale, the frequency of experiencing MSD in the past working week is rated across the following anchors: ‘Never’, ‘1–2 times last week’, ‘3–4 times last week’, ‘Once every day’ and ‘Several times every day’ with weights of 0, 1.5, 3.5, 5, and 10, respectively. On the severity scale, the severity of the experienced MSD is rated across the following anchors: ‘Slightly uncomfortable’, ‘Moderately uncomfortable’ and ‘Very uncomfortable’ with weights of 1, 2, and 3, respectively. On the work interference scale, the interference of the experienced MSD with ability to work is rated across the following anchors: ‘Not at all’, ‘Slightly interfered’ and ‘Substantially interfered’ with weights of 1, 2 and 3, respectively [40].

The score of the relevant body region is calculated by multiplying the discomfort, frequency and interference. It can be concluded that the risk score for a body region can vary from 0 to 90. The researchers derived the final scores and ranked the discomfort/pain level in the office workers as follows: 0 = no discomfort (0 score); 1 = mild (1.5 –4.5 score); 2 = moderate (5 –14 score); 3 = severe (15 –45 score); 4 = very severe (60 –90 score) [2], which are defined as “health risk level’.

2.3 Rapid office strain assessment

ROSA method is a pen-and-paper checklist and a risk factor screening tool intended to recognize the necessity on the job intervention at an office workplace.

The method was developed in 2011 by Sonne et al. [11] and was designed to quickly quantify the risks associated with computer work and to suggest how posture can be improved [19]. The method allows to quickly quantify risk factors related to workstation considering workplace posture and equipment assessment. The ROSA aims to serve as a screening tool to identify priority areas in large office-based organizations.

The ROSA method has three main sections: a) chair, b) monitor and telephone, c) keyboard and mouse. The maximum scores from each of the sections are used as the horizontal and vertical axes for the sub-section scores (which were subsequently used to obtain the ROSA final score). Section A provides the chair score (2–9 points). Section B is composed by telephone and monitor resulting in the monitor (1–7 points) and telephone scores (1–6 points). Section C provides the keyboard (1–7 points) and mouse (1–7 points) scores. The scores from the monitor and telephone and keyboard and mouse are then compared in another chart to receive the peripheral score [12]. By using the interaction matrix of both the chair’s risk score and the common risk score of the other equipment, the overall ROSA risk score is calculated. The ROSA final score (1–10 points) is derived by comparing the peripheral chart against the chair score. 4 risk levels were low, medium, high and very high. In each risk level, the definition and score were: Low-risk level: score 1–2; Medium risk level: score 3–4; High-risk level: score 5–7; and Very high-risk level: 8–10 points [28].

Final scores greater than 5 (high or very high risk) indicate the need for further ergonomics assessment and the workstation improvements. In the case of very high risk, improvements are urgently required [2].

The participants completed the demographic and Cornell questionnaires at their workplaces. The evaluation of the ROSA form was conducted in a convenient time for the employee. The appropriate figure for each equipment and the related score was selected. Employees’ usage duration and the height, depth and adjustability of the office equipment were taken into account. After the office equipment was ergonomically checked, the related charts were used to calculate the score from each part, and eventually, the final ROSA score was derived by comparing the peripheral charts.

3 Results

In this study, two different methods, the Cornell questionnaire and ROSA method, were used simultaneously to analyse MSDs among employees. The Cornell questionnaire was applied to assess the level of pain among employees. The ROSA method was used to quantify ergonomic risk factors associated with each component of an office workplace. Data were collected from a total of 208 employees working in the office workplaces permanently.

Statistical analyses were carried out using SPSS 24 statistical software for Windows. A one-way analysis of variance (One-Way ANOVA procedure) and independent t-tests for equality of means was performed to investigate whether there were significant differences between departments. Scheffe’s multiple comparison test (post hoc test) was run for comparing the difference between each pair of means with an appropriate adjustment (p values) for the multiple testing. In all the tests, the confidence level is 95%.

The age of participants ranged from 22 to 62 (mean 36.21, std. dev. 8.02) years. Most of them (42%) were in the age range of 30–39 years. The majority (168) were male, 80.77%of the employees. All individuals had at least one year of experience in their current jobs. The average experience at work was 10.68 (sin td. dev. 7.30) years and 45.67%had 5–15 years of experience.

3.1 Cornell questionnaire

According to the questionnaires filled in by the 208 office employees, body regions’ discomforts regarding the total complaints are presented in Table 1. Neck discomforts which are thought to be due to long hours of desk job have the highest percentage of 32.26%. Usually caused by the inappropriateness of the back support of chairs, upper back (22.26%) and lower back (23.23%) have also a high score. Shoulder discomforts, which are thought to be caused by chair-table height incompatibility and prolonged computer usage, also have a significant percentage (8.45%and 5.65%).

Table 1
The results of the Cornell questionnaire

a. Frequencies

During the last work week how often did you experience ache, pain, discomfort in: If you experienced ache, pain, discomfort, how uncomfortable was this? If you experienced ache, pain, discomfort, did this interfere with your ability to work?

Body region Never 1-2 times last week 3-4 times last week Once every day Several times every day Slightly uncomfortable Moderately uncomfortable Very uncomfortable Not at all Slightly interfered Substantially interfered

Neck 65 71 37 16 19 84 56 3 100 41 2

Shoulder Right 111 57 23 8 9 59 36 2 70 25 2

Left 119 56 16 12 5 57 31 1 68 19 2

Upper Back 80 65 35 11 17 80 44 4 93 30 5

Upper Arm Right 174 19 8 5 2 25 9 0 30 4 0

Left 186 15 5 2 0 18 4 0 19 3 0

Lower Back 86 57 34 14 17 60 58 4 80 38 4

Forearm Right 179 15 7 6 1 20 8 1 23 6 0

Left 185 16 4 3 0 17 6 0 18 5 0

Wrist Right 134 43 16 8 7 44 28 2 46 26 2

Left 166 31 7 3 1 29 13 0 29 13 0

Hip/Buttock 162 24 13 5 4 29 16 1 38 6 2

Thigh Right 175 17 10 4 2 25 7 0 29 3 0

Left 177 16 10 4 1 24 7 0 28 3 0

Knee Right 162 31 10 3 2 35 9 2 40 4 2

Left 162 31 10 3 2 35 9 2 40 4 2

Lower Leg Right 176 18 11 3 0 25 7 0 28 4 0

Left 178 16 11 3 0 23 7 0 26 4 0

	During the last work week how often did you experience ache, pain, discomfort in:	If you experienced ache, pain, discomfort, how uncomfortable was this?	If you experienced ache, pain, discomfort, did this interfere with your ability to work?
Neck		65	71	37	16	19	84	56	3	100	41	2
Shoulder	Right	111	57	23	8	9	59	36	2	70	25	2
	Left	119	56	16	12	5	57	31	1	68	19	2
Upper Back		80	65	35	11	17	80	44	4	93	30	5
Upper Arm	Right	174	19	8	5	2	25	9	0	30	4	0
	Left	186	15	5	2	0	18	4	0	19	3	0
Lower Back		86	57	34	14	17	60	58	4	80	38	4
Forearm	Right	179	15	7	6	1	20	8	1	23	6	0
	Left	185	16	4	3	0	17	6	0	18	5	0
Wrist	Right	134	43	16	8	7	44	28	2	46	26	2
	Left	166	31	7	3	1	29	13	0	29	13	0
Hip/Buttock		162	24	13	5	4	29	16	1	38	6	2
Thigh	Right	175	17	10	4	2	25	7	0	29	3	0
	Left	177	16	10	4	1	24	7	0	28	3	0
Knee	Right	162	31	10	3	2	35	9	2	40	4	2
	Left	162	31	10	3	2	35	9	2	40	4	2
Lower Leg	Right	176	18	11	3	0	25	7	0	28	4	0
	Left	178	16	11	3	0	23	7	0	26	4	0

b.Risk scores

Body region	Frequency	Discomfort	Interference	Score	%
Neck		506^*	205	188	19501240^**	32.26
Shoulder	Right	296	137	126	5109552	8.45
	Left	250	122	112	3416000	5.65
Upper Back		445	180	168	13456800	22.26
Upper Arm	Right	101.5	43	38	165851	0.27
	Left	50	26	25	32500	0.05
Lower Back		444.5	188	168	14039088	23.23
Forearm	Right	87	39	35	118755	0.20
	Left	53	29	28	43036	0.07
Wrist	Right	230.5	106	104	2541032	4.20
	Left	96	55	55	290400	0.48
Hip/Buttock		146.5	64	56	525056	0.87
Thigh	Right	100.5	39	35	137182,5	0.23
	Left	89	38	34	114988	0.19
Knee	Right	116.5	59	54	371169	0.61
	Left	116.5	59	54	371169	0.61
Lower Leg	Right	80.5	39	36	113022	0.19
	Left	77.5	37	34	97495	0.16

(^*)Frequency score = 65^*0 + 71^*1.5 + 37^*3.5 + 16^*5 + 19^*10 = 506. (^**) Score for neck = 506^*205^*188 = 19501240.

An analysis of the health risks of the neck, upper and lower back was performed and the results are shown in Table 2. For 21.6%of the office employees, the health risk was moderate, and for 10.1%, the risks were high to very high. Similar results were found for the other body regions. The overall health risks of the office staff were 31.7%, 26.9%and 29.3%, ranged from moderate to very high level for the neck, upper and lower back, respectively.

Table 2

The number and percentage of office employees classified by the level of health risk

Health risk level	Neck	Upper back	Lower back
0 = no risk (0 score)	65 (31.3 %)	80 (38.5 %)	86 (41.3 %)
1 = low (1.5 –4.5 score)	77 (37.0 %)	72 (34.6 %)	61 (29.3 %)
2 = moderate (5 –14 score)	45 (21.6 %)	36 (17.3 %)	39 (18.8 %)
3 = high (15 –45 score)	19 (9.1 %)	15 (7.2 %)	19 (9.1 %)
4 = very high (60 –90 score)	2 (1.0 %)	5 (2.4 %)	3 (1.4 %)

The health risk levels (0–4) of the neck, shoulder (right and left) and back (upper and lower), which are the body regions where most of the discomforts encountered, is located in Table 3 according to departments. The departments were classified into 3 categories; a) manufacturing (3 departments, 52 employees), b) manufacturing aided (4 departments, 77 employees), c) administrative and financial departments (5 departments, 79 employees). Ergonomic risk of neck discomfort was the greatest in Accounting and Design departments. Shoulder discomforts for Accounting and Sub Industry, upper back discomforts for Sub Industry and Accounting, lower back discomforts for Production Planning and Manufacturing Management were related and have higher risks than the other departments. Whether there is a significant difference in average-risks between departments was analysed by One-Way ANOVA. With 95%confidence level, no significant difference was found between departments.

Table 3

The health risk levels of neck, shoulder (right and left) and back (upper and lower) for departments

Department category	Department	n	Neck	Shoulder (Right)	Shoulder (Left)	Upper Back	Lower Back
Manufacturing	Manufacturing Management	16	1.188	0.813	0.688	1.313	1.688
	Montage	5	0.600	0.600	0.600	1.000	0.800
	Manufacturing Engineering	31	1.000	0.548	0.484	0.806	0.774
Manufacturing Aided	Quality Assurance	42	1.214	0.619	0.571	1.024	0.738
	Production Planning	8	0.750	0.500	0.375	0.750	1.750
	Maintenance	6	0.833	0.667	0.167	0.667	0.833
	Job Development	11	0.909	0.364	0.545	1.000	1.091
	Research and Development (R&D)	10	1.100	0.700	0.700	1.000	1.000
Administrative and Financial	Accounting	8	1.875	1.500	1.250	1.500	1.500
	Purchasing	12	1.167	1.167	1.083	1.167	0.833
	Sub Industry	5	1.400	1.400	1.400	1.800	1.200
	Human Resources Management (HRM)	32	0.938	0.719	0.469	0.844	1.000
	Information Technology (IT)	14	1.286	0.714	0.786	1.071	1.214
	Design	8	1.500	0.500	0.375	0.875	0.500
	All	208	1.115	0.712	0.620	1.005	1.000

3.2 Rapid office strain assessment

Table 4 presents the results of physical exposure assessment to MSD risks with ROSA among the office employees. The mean ROSA final score was 3.52 (s.d. = 0.71) while chair, monitor and telephone and mouse and keyboard sections were 3.30, 2.16 and 2.69, respectively (Table 4.a). It is clear that chair score was higher than the others. It was found that the scores were 3.86 for chair height and pan depth and 3.04 for the armrest and back support. Thirty-nine (18, 8%) of 208 office stations was found ergonomically risky (risk score over 5). The most important cause of the high-level risk has been found as the height and depth of chairs.

Table 4a
Assessment of physical exposure to MSDs with ROSA among office employees\\ a. Scores for office equipment

Office equipment Minimum Maximum Mean Std.dev.

Chair 1.0 8.0 3.303 1.1587

Height and pan depth 3.0 6.0 3.856 0.7915

Armrest and back support 2.0 7.0 3.038 0.9522

Monitor and Telephone 1.0 7.0 2.183 1.1316

Monitor 0.0 5.0 2.447 1.1408

Telephone 0.0 5.0 1.149 1.3662

Mouse and Keyboard 1.0 6.0 2.692 1.0175

Mouse 0.0 4.0 1.837 0.8913

Keyboard 0.0 5.0 2.500 0.9428

ROSA 1.0 8.0 3.519 1.1957

Office equipment	Minimum	Maximum	Mean	Std.dev.
Chair	1.0	8.0	3.303	1.1587
Height and pan depth	3.0	6.0	3.856	0.7915
Armrest and back support	2.0	7.0	3.038	0.9522
Monitor and Telephone	1.0	7.0	2.183	1.1316
Monitor	0.0	5.0	2.447	1.1408
Telephone	0.0	5.0	1.149	1.3662
Mouse and Keyboard	1.0	6.0	2.692	1.0175
Mouse	0.0	4.0	1.837	0.8913
Keyboard	0.0	5.0	2.500	0.9428
ROSA	1.0	8.0	3.519	1.1957

Office equipment which has a risk score of 5 or above is given in Table 4b. Chair (height and depth) has been identified as the highest factor. The most important two reasons for the high score in these chairs: lack of appropriate height in 23%of chairs (height lower or higher), and inappropriate depth in 56%of the chairs (depth short or long).

Table 4b

b.Office equipment with high risk (ROSA risk score ≥5)

Office equipment	Number	%
Chair –Height and pan depth	40	19.23
Chair –Armrest and back support	12	5.77
Monitor	8	3.85
Telephone	4	1.92
Mouse	0	0
Keyboard	7	3.37

The average ROSA scores of the departments are presented in Table 5. Chair seating surface was determined to be unsuitable for sub-industry and design departments. Armrests and backrests were unsuitable for production planning and manufacturing directorate; the monitor was unsuitable for purchasing and Sub Industry departments; the phone was unsuitable for accounting, and the keyboard was unsuitable for Sub Industry and Accounting departments.

Table 5

ROSA scores for departments

Department Category	Departments	n	Chair –Height and pan depth	Chair –Armrest and back support	Monitor	Telephone	Mouse	Keyboard	All
Manufacturing	Manufacturing Management	16	3.875	3.938	2.188	1.438	1.813	2.438	3.688
	Montage	5	4.000	2.600	2.000	0.000	1.800	2.400	3.600
	Manufacturing Engineering	31	3.968	2.935	2.387	0.968	1.452	2.290	3.258
Manufacturing Aided	Quality Assurance	42	3.952	3.143	2.143	1.214	1.643	2.500	3.571
	Production Planning	8	3.500	3.625	2.375	0.625	1.750	2.500	3.250
	Maintenance	6	3.667	2.500	1.333	1.667	1.167	1.667	2.500
	Job Development	11	3.727	2.545	2.182	1.091	1.909	2.545	3.455
	Research and Development	10	4.100	3.300	2.400	0.500	1.500	2.300	3.700
Administrative and Financial	Accounting	8	3.750	2.875	3.500	2.000	2.000	3.500	4.375
	Purchasing	12	3.583	2.833	3.667	1.833	2.167	2.833	3.833
	Sub Industry	5	4.800	3.200	3.600	1.800	2.800	3.600	4.600
	Human Resources Management	32	3.750	2.938	2.219	0.938	1.969	2.219	3.188
	Information Technology	14	3.429	2.714	2.643	1.143	2.500	2.714	3.357
	Design	8	4.250	2.875	3.375	1.250	2.375	2.875	4.375
Total		208	3.856	3.038	2.447	1.149	1.837	2.500	3.519

3.3 Correlations between Cornell and ROSA scores

Table 6 depicts the correlation between the Cornell score in all body regions and the final ROSA score. As shown in the table, the discomforts in the neck (r = 0.362), upper back (r = 0.404) and lower back (r = 0.368) were moderately and positively correlated with the final ROSA score.

Table 6
Correlation between Cornell scores and the final ROSA score

Body regions r

Neck 0.362^

Shoulder Right 0.312^

Left 0.360^

Upper Back 0.404^

Upper Arm Right 0.319^

Left 0.360^

Lower Back 0.368^

Forearm Right 0.319^

Left 0.253^

Wrist Right 0.226^

Left 0.357^

Hip/Buttock 0.338^

Thigh Right 0.312^

Left 0.329^

Knee Right 0.245^

Left 0.245^

Lower Leg Right 0.344^

Left 0.342^

Body regions		r
Neck		0.362^**
Shoulder	Right	0.312^**
	Left	0.360^**
Upper Back		0.404^**
Upper Arm	Right	0.319^**
	Left	0.360^**
Lower Back		0.368^**
Forearm	Right	0.319^**
	Left	0.253^**
Wrist	Right	0.226^**
	Left	0.357^**
Hip/Buttock		0.338^**
Thigh	Right	0.312^**
	Left	0.329^**
Knee	Right	0.245^**
	Left	0.245^**
Lower Leg	Right	0.344^**
	Left	0.342^**

^**Correlation is significant at the 0.01 level (2-tailed). ^* Correlation is significant at the 0.05 level (2-tailed).

4 Discussion

This study was carried out to investigate MSDs in the office workplaces of 208 employees working 14 departments in a big sized manufacturing company using ROSA method and Cornell questionnaire.

The Cornell questionnaire results showed that the highest prevalence rates of MSD symptoms were related to the neck (32.26%) caused by prolonged work times in desk-jobs and upper back (22.26%) and lower back (23.23%) which point the inappropriateness of the backrest. Shoulder discomforts and pains, which are thought to be caused by chair-table height incompatibility, had a significant percentage (8.45%and 5.65%) too. Lower back discomforts and pains which can be caused by prolonged usage and misuse of office equipment such as phone, keyboard and mouse had also an observable percentage of∼5%. Discomforts in the lower body were at a lower level (less than 1%), of which hip and knee had much more risks. These complaints are generally due to incorrect seating position and non-adjustable seating depth of the chair. Other research [10, 16] found that the neck, upper and lower back had the highest prevalence rates of MSDs among office employees. The results coincided with each other. The most important reasons underlying these discomforts of the employees are; inappropriate workstation design (inappropriateness of the office equipment to the user), wrong adjustment of adjustable equipment, lack of education of the risk reduction methods, lack of information about the inappropriateness of the office equipment and lack of understanding to comprehend the relation between discomforts and equipment.

The results showed that the mean ROSA score was 3.52 (s.d. = 0.71); the score was 3.86 for chair height and depth section, and 3.04 for the armrest and back support section. There were two reasons for the high score in the office chair: the first one was the lack of appropriate height (lower or higher) in 23%of the chairs and the second one was the inappropriate depth (short or long) in 56%of the chairs, which results in pain in the user’s neck and arm, causing more fatigue due to static force. The majority of chairs (81.25%) had suitable armrests for users, although 66.35%of the employees’ lumbar supports were not suitable for them. 40.87%of the employees were leaning while working although they had back support, which causes back pains. The results of the ROSA highlighted that the mean score of the chair section was higher than that of the other sections (mouse and keyboard section, and monitor and telephone section). This result shows that the parameters associated with the chair section should be considered as a priority and should be corrected.

It is quite an interesting result that 55%of employees’ monitor heights were either low or high for themselves. Monitor height is particularly important for those who work long hours looking at the monitor, such as accountants, IT experts, designers and R&D employees. Employees in these conditions are especially exposed to neck pains. ∼15%of the employees work by twisting their wrists (bending angle > 15°) and ∼10%of the employees worked by bending their wrist. This causes pain in the wrist and carpal tunnel syndrome. In order to prevent the wrist angle of 15° employees should use wrist support. This way, there won’t be any angle between the hand and elbow and the wrist muscles will be relaxed.

Gender, experience and age of the employees, and the discomforts in the body regions where most of the discomforts are encountered, such as the neck, back, and shoulder were analysed. The findings showed a significant association between gender and risk level of three body regions. During the last work week, the percentages of at least 1-2 times pain/discomfort in the neck body were 65.5%for male and 82.5%female employees. Similarly, the health risk levels were 1.50 for female and 1.02 for male employees. The scores for the right and left shoulders of female employees were higher than male employees. The employed women’s exposure to neck factors at both work and home usually differs widely from employed men’s exposure. The biological differences between men and women and housekeeping duties are also reasons for these differences. Because of less muscle strength, anthropometric dimensions, and hormonal changes in women, they more susceptible to MSDs than men [41]. The analysis conducted for the frequency, discomfort and interference with the ability to work showed that the age and experience had a positive but weak effect on discomforts. However, the employees aged 30–39 years reported high pain complaints than those who were older. The health risk levels of neck region were 1.32 (79.2%) for aged 30–39 years and 0.98 (66%) for aged 40–49 years.

Frequency scores of the chair, monitor, telephone, mouse and keyboard were analysed by using correlation analysis to indicate the correlation between them and neck, back and shoulder discomforts. It was found that there were positively and moderately correlations between chair seating surface (height and depth) section and neck (r = 0.235) and shoulder (r = 0.259 and r = 0.266) discomforts; chair armrest and back support section and upper back (r = 0.436) and lower back (r = 0.457) discomforts; monitor and telephone section and neck discomforts (r = 0.405); and mouse and keyboard section and shoulder discomforts (r = 0.307. r = 0.375).

Employees’ work characteristics may vary dep-ending on the department. Therefore, use of office equipment and usage time were different from each other. For example, some employees of some departments, as required by the nature of their works, could spend more time to work sitting in the chair. Upon analyzing personnel’s use of the office equipment, it was found that 56.25%spend sitting in the chair continuously; 53.37%look at the monitor for more than 4 hours a day; 45.19%use the telephone less than 1 hour a day; 54.33%use mouse for more than 4 hours a day; and 46.64%use keyboard for more than 4 hours a day.

The departments in which employees work more than 4 hours sitting in their chairs were Accounting, IT, Design, Job development and R&D. In these departments, the dimension of the office chair must be determined by employees’ anthropometric measurements; and if adjustable chairs are used, the employees must be given information of how to properly adjust these chairs. The departments in which monitor, mouse and keyboard used most were Accounting, IT, Design and R&D. Training and educations about monitor height settings, choice of the mouse depending on the hand size and pad usage, ergonomic keyboard and wrist support usage should be introduced to the employees in these departments. There was no dominant department found in the study regarding telephone usage.

In this study, the mean scores were found 3.52 (s.d. = 0.71) for ROSA final, 3.30 for chair section, 2.18 for monitor and telephone section and 2.69 for mouse and keyboard section. However, the score was 3.86 for chair height and depth section and 3.04 for the armrest and back support. Working in ergonomically risky offices causes pain in neck (32.26%), shoulder (5.65%and 8.45%) lower back (23.23%) and upper back (22.26%). The results of a limited number of studies using ROSA method and Cornell questionnaire were significantly consistent with the results of this study. In the study conducted by Matos and Arezes [25], while the mean ROSA final score was 3.61 (s.d. = 0.64), the chair, monitor and telephone, mouse and keyboard sections were 3.45 (s.d. = 0.55), 3.11 (s.d. = 0.61) and 2.11 (s.d. = 0.31), respectively. Poochada and Chaiklieng [28] assessed ergonomics risk for MSDs in work environment among 216 call centre workers by using ROSA method. The results showed that the majority (52.3%) of the call centre workers were at a high-risk level (score 5–7 points). Ghanbary Sartang and Habibi [15] investigated the assessment of MSDs among 96 computer users in Isfahan University with ROSA method and Nordic questionnaire. Posture evaluation by ROSA method indicated 19 users (19.8%) in the low-risk level and 27 people (28.1%) in the high-risk level. The average ROSA score was 4.93. Özkan and Kahya [16] investigated ergonomic risk factors in a university’s 92 offices through ROSA and Cornell methods. According to the Cornell questionnaire results; neck discomforts thought to be caused by long work hours in desk jobs and shoulder pains thought to be caused by chair-desk height incompatibility and prolonged computer usage have the highest rates (18.69%and 18.16%). Upper back (16.49%) and lower back (10.87%) discomfort rates were also high. According to the ROSA results, 36 offices of 92 were found ergonomically risky, while the riskiest office equipment (30.43%) was found as the chair section.

Office employees interact with much office equipment for long hours. Studies have shown that in-appropriate arrangement of office equipment (e.g. monitor, chair, telephone) to the employees or their misuse of this equipment are causes of their discomforts in neck, back and shoulder regions. To ensure comfort and to increase the productivity of employees, it is of major importance for any type of workstation to be ergonomically designed.

This study has some limitations. The major limitation is the generalizability. This is a cross-sectional study conducted in a large-sized company from a manufacturing sector where data were gathered from 208 employees in the offices of 14 departments. Further research with greater sample sizes from different companies should be conducted to confirm the findings. Secondly, since this study was carried out among office employees, the results cannot be generalized to other working groups.

5 Conclusion

In this study, the office workplaces of 208 employees in a large-scale enterprise were ergonomically evaluated using Cornell questionnaire and ROSA method. With the help of the simultaneous use of the two methods, an analysis was conducted to determine whether MSDs in the results of the Cornell questionnaire are caused by office conditions. The results show that most of the discomforts generally occurred in the neck, back and shoulder regions of the body. The ROSA results revealed that the highest risk factors were the chair, monitor and the combined effects of the desktop equipment (monitor, telephone, keyboard and mouse). Correlation analysis confirmed that the position while using the monitor, telephone, mouse; increase the shoulder, back and neck disorders. Statistically significant results were obtained between the relation regarding the ergonomic inappropriateness of the offices and the increase of MSDs in these body regions. These results indicate that the employees work long hours sitting on the chair and also in improper positions; the monitor height and armrest are not appropriate.

Office furniture cannot be expected to ensure full conformity with every user’s body dimensions; even they are made regarding anthropometric measurements. It is particularly preferred that the depth and height of office equipment should be adjustable. However, the high price of adjustable equipment is an obstacle for their availability in all offices. Even if equipment sections can be adjusted, there could be people who do not know how to adjust size properly or who do not have information about this feature at all. Employees should thus be informed about height adjustment.

For a more efficient performance of the personnel working in the office, a comprehensive approach to the scope of this study has been proposed to estimate the discomfort felt by the employees, which can be solved with simple office arrangements. Statistical analysis made with observation and information gathering methods based on the employees is likely to reduce staff absence related to MSDs.

Footnotes

Acknowledgments

The author would like to thank Murat Erkara for the contribution during the measurements in the company.

Conflict of interest

The author declares no conflict of interest.

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