Mental workload,musculoskeletal discomfort and physical activity level in master’s degree students in the COVID-19 context: A pilot study

Abstract

BACKGROUND:

The coronavirus disease 2019 (COVID-19) pandemic has led to a change of pedagogical strategies from on-campus to “online” modality (synchronous and asynchronous learning) and may influence the health of university students, including their mental workload.

OBJECTIVE:

To identify the association between mental workload, perception of musculoskeletal discomfort (MSD), and the level of physical activity of Masters’s students’ online learning due to the pandemic.

METHOD:

This was a pilot descriptive study with a cross-sectional, quantitative, non-experimental study design. The sample consisted of 20 students. To collect the data, the participants answered a sociodemographic questionnaire, NASA-Task Load Index, International Physical Activity Questionnaire, and the Nordic Musculoskeletal Questionnaire.

RESULTS:

The students presented mental workload at medium (45%) and high (55%) levels, with time demands as the most prevalent dimension. In addition, 80% of the students reported experiencing MSD in the last seven days, with the most frequent areas being the neck and lower back. Regarding the level of physical activity, five students had a low level (25%), five students had a medium level (25%), and ten students had a high level (50%) of activity.

CONCLUSION:

Most of the students (95%) conduct their master's degree along with maintaining a full-time job. Therefore, the adaptive requirements according to “time demands” is a negative factor because of its contribution to mental workload. Especially in addition to students’ perception of musculoskeletal discomfort, organizational aspects would be fundamental to prevent physical and mental health risks.

Keywords

Mental health students pain perception questionnaire online teaching

1 Introduction

On December 31, 2019, the World Health Organization (WHO) declared a global pandemic due to the coronavirus disease 2019 (COVID-19). On March 3, 2020, the first coronavirus case was registered in Chile, and on March 18, the President of the Republic of Chile decreed a state of national catastrophe. Subsequently, restrictive measures were implemented, such as night curfew and total quarantine, suspending face-to-face activities such as classes, mass events, and “non-essential” work. As a result, the population, specifically university students, had to stay home and comply with governmental mandates.

University students in different parts of the world have been affected by the COVID-19 pandemic due to the change in the mode of study from face-to-face to “online” mode, having to stay at home to study in the distance mode, which has had negative consequences, such as increased mental stress [1, 2]. Additionally, recent studies conducted in China [3], Albania [4], Croatia [5], and Australia [6] have found a high prevalence of depressive and anxiety symptomatology in university students during the pandemic. The same consequences were observed among teleworkers in Brazil; they presented anxiety and irritability but also gained weight and pain primarily located in the lower back, neck, and shoulders, affecting the worker’s well-being [7].

In the United Kingdom, a study conducted on the behavior and mental health of students concluded that well-being and physical activity decreased during quarantine, finding a direct relationship between stress and sedentary behavior (r = 0.18, p < .010), thus identifying that the pandemic has negatively affected this population [5]. Additionally, physical activity is a concern for universities as regular activity reduces the onset of depression in adults and acts as a symptom reducer in adolescents and young adults [8 –10].

The literature highlights the pandemic’s worldwide consequences on mental health, such as increased stress, depression, anxiety, post-traumatic stress disorders, and sleep disorders [11, 12]. The diminished mental health interferes with people’s lives and the new academic reality that they must meet.

According to the literature, university students tend to have poor eating habits and little physical activity, and these conditions are worsened by COVID-19 and staying at home. In addition, the research found that sedentary behavior increased from should this be 8.3 to 11 hours per day during this period, representing a high-risk factor for metabolic and cardiovascular disease and lower cognitive function [13, 14].

Mental workload is “the cognitive and emotional pressure resulting from coping with the demands associated with the exercise of work” [15]. This can be influenced by environmental, organizational, physical, and psychological factors, affecting job performance as a person interacts with different elements and aspects within a system, and individual characteristics must be considered [15]. One of the main consequences associated with the high mental workload is the effect at a physical level since it is related to the development of musculoskeletal disorders [16], which, internationally, is one of the most important occupational health problems in developed and developing countries [17].

Musculoskeletal disorders (MSDs) are injuries associated with body tissues that can generate physical and functional alterations at different levels: musculoskeletal, articular, bone, etc. Symptoms vary from mild discomfort and pain related to inflammation and decrease or loss of muscle strength to functional limitation of the affected body segment [18, 19].

Among college students, it has been observed that, during COVID, MSDs are most related to prolonged periods of device use. Rahul et al. suggested “that physical activity intervention (PAI) can reduce the risk of long-term MSDs in different body regions” such as the wrist/forearm, low back, and elbow [20]. In addition, they exposed a correlation between psychosocial and emotional factors with MSDs among students and mentioned other relevant contextual factors, such as lack of adequate connectivity and furniture [21].

Studies show the presence of discomfort in the back, neck, and arms associated with prolonged technology use in university students [22]. These physical problems are associated with using technologies such as laptops/notebooks to support academic activities for more than 4 hours [21]. This situation is related to awkward and prolonged postures that can cause pain and musculoskeletal disorders, especially at the level of the spine and upper limbs [23].

There is a lack of evidence that associates these three variables: mental workload, perception of musculoskeletal discomfort (MSD), and physical activity, especially in the context of university students during the pandemic. Therefore, providing guidance or improving the management of risk factors will be the basis for managing them appropriately and developing preventive strategies with a systemic approach that considers graduate students’ physical and mental health.

Therefore, this research aimed to describe and identify whether there was an association between mental workload, perception of musculoskeletal discomfort, and level of physical activity among Master in Public Health students of the Faculty of Medicine of the University of Chile during the COVID-19 pandemic.

2 Method

2.1 Methodological design

This was descriptive study with a cross-sectional, quantitative, non-experimental design, as it described a situation in each context, specifically in the Master of Public Health students at the University of Chile, with the variables studied and analyzed at a given time. The data collection used an electronically administered self-report of four questionnaires between April and September 2021.

2.2 Population

All 103 first and second-year students of the Master of Public Health of the Faculty of Medicine were invited to participate in the study.

2.3 Sample

All first and second-year students (103) were invited to participate, 26 completed the questionnaire, and 20 met the inclusion criteria. Inclusion criteria: To be a student of the Master of Public Health of the Faculty of Medicine of the University of Chile, 2020-2021. Exclusion criteria: Currently pursuing two or more formal technical-university studies (whether postgraduate, master’s, courses, or others) simultaneously. Present any musculoskeletal pathology diagnosed in the last 12 months.

2.4 Variables

The study variables were sociodemographic to characterize the sample and three specific variables:

Perception of musculoskeletal discomfort for this study was defined as: a psychic function that allows the organism, through the senses, to receive, process, and interpret the perception of musculoskeletal pain as a concrete and localized experience of discomfort, which may increase or decrease depending on the task performed by the person. The Nordic Questionnaire was used to assess the subjective perception of musculoskeletal complaints [24]. The mental workload for this student was defined as the set of physical and mental activities to which the worker is exposed and is made up of six dimensions: mental demand: this is the load or order at a cognitive level, determined by the amount and type of information to be processed in a job: the physical demand dimension is the load or charge at a physical level; the time demand dimension is the load or time condition to perform a task or activity; the performance dimension corresponds to obtaining good results by carrying out a given exercise with a minimum cost, either in human or material resources; the effort dimension is the action that involves both a mental and physical load to achieve an objective; the frustration dimension corresponds to a situation of emotional stress in which a subject is confronted with a problem and feels disappointed in their expectations of reward; feeling of pressure, discouragement, and insecurity during the performance of a task. The mental workload was measured using the NASA-TLX method [15, 25]. The calculation of a total workload score was classified as high (if the total score was greater than 1000), medium (if the score was 501 to 1000 points), and low (if the score was less than or equal to 500).

Physical activity is “Any bodily movement produced by skeletal muscles and resulting in energy expenditure” [27].

Physical activity level was measured using the IPAQ questionnaire [26, 27]. The measure collects information on the frequency of physical activity per week and the time (in minutes) spent carrying out physical activity and sitting. The physical activity is classified as high, medium, or low level, depending on the time in which the physical activity was performed (intense, moderate, and walking).

2.5 Data collection techniques

Data collection was conducted between May and October 2021. The Master’s coordinator sent the invitation to participate in the study by email, with access to the informed consent and the four questionnaires to be answered only once in Google Form format. The questionnaires were answered in 40 minutes, and the deadline was ten days.

2.6 Statistical analysis

A quantitative analysis of the results processed the data through descriptive statistics, analyzing the data for each variable considering frequency distributions and measures of central tendency using Statistical Package for Social Sciences Software (SPSS) version 26 software (IBM Corp., Armonk, NY, USA).

3 Results

3.1 Sociodemographic analysis of the study sample

Results are presented for 20 participants. Of the students who answered the questions, ten (50%) were female, and ten (50%) were male. The age average and range were 35.9 + /- 7.88 years old.

Regarding employment status, 8 people (40%) were employed with full-time employment, 7 (35%) were employed with an indefinite contract (contract with the agreement without an expiry date), 4 people (20%) were employed on a freelance basis, and one of them (5%) has a contract in the public sector, with temporary employment that can be extended one time per year. In addition, 11 people (55%) worked in healthcare centers, and 9 people (45%) did not work in health centers.

Regarding the weekly hours dedicated to online classes, the mean was 13.2 hours, with a standard deviation of 5.9. The weekly hours of self-study presented a mean of 12 hours with a standard deviation of±6.0. A mean of 35.8 working hours per week with a standard deviation of 15.3 (Table 1).

Table 1
Results of the hours of dedication to online classes and work during the master’s degree (n = 20)

Variable Media Standard deviation (SD) Me Minimum value Maximum value

Hours per week dedicated to online classes (min) 13.2 ±5.9 13.0 5 22

Hours per week dedicated to study (min) 12.0 ±6.0 10.5 4 30

Hours per week dedicated to work (min) 35.8 ±15.3 44.0 0 48

Variable	Media	Standard deviation (SD)	Me	Minimum value	Maximum value
Hours per week dedicated to online classes (min)	13.2	±5.9	13.0	5	22
Hours per week dedicated to study (min)	12.0	±6.0	10.5	4	30
Hours per week dedicated to work (min)	35.8	±15.3	44.0	0	48

The scores obtained are presented by means of the median (Me) and minimum and maximum values.

3.2 Level of physical activity in Master of Public Health students

According to the IPAQ Questionnaire, 5 students reported a low level of physical activity (25%), 5 students (25%) reported a medium level, and 10 students reported a high level of physical activity (50%). Students reported a maximum of 360 minutes per week doing intense physical activity (median 60 minutes), a maximum of 640 minutes of moderate activity (median 0 minutes), and a maximum of 1260 minutes walking per week with a median value of 135 minutes. Likewise, they described a maximum time of 900 minutes per week sitting with a median value of 405 minutes (Table 2).

Table 2
IPAQ Questionnaire. Results on time (in minutes) per week spent in intense or moderate physical activity, walking and sitting (n = 20)

Variables (minutes) Me Minimum value Maximum value

Minutes per week intense activity (min) 60 0 360

Minutes per week moderate activity (min) 20 0 640

Minutes per week walking (min) 135 25 1260

Minutes per week sitting (min) 405 180 900

Variables (minutes)	Me	Minimum value	Maximum value
Minutes per week intense activity (min)	60	0	360
Minutes per week moderate activity (min)	20	0	640
Minutes per week walking (min)	135	25	1260
Minutes per week sitting (min)	405	180	900

The scores obtained are presented by means of the median (Me), minimum and maximum values.

3.3 Perceived level of mental workload in Master of Public Health students

According to the NASA-TLX Questionnaire, 9 students (45%) reported having a medium mental workload, and 11 students (55%) had a high mental workload.

In addition, it was evidenced that “temporal demand” was the dimension that contributed the most to the mental workload with 28.6%, followed by the dimension “mental demand,” “performance,” and “effort,” which contributed 22%, 20%, and 19.6% respectively (Table 3). The “frustration” and “physical demand” dimensions contributed the least to the mental workload of the students, being 8.7% and 1.1%, respectively (Table 3).

Table 3
Contribution of each dimension of mental workload in the total weighted score of all responses (n = 20)

Weighted scores Total score Percentage distribution (%) Me Minimum value Maximum value

Mental demand 4350 22 225 0 400

Physical demand 215 1.1 0 0 105

Temporary requirement 5650 28.6 320 80 500

Performance 3955 20 150 40 475

Effort 3870 19.6 190 50 340

Frustration 1725 8.7 60 0 300

Total 19765 100 1087.5

Weighted scores	Total score	Percentage distribution (%)	Me	Minimum value	Maximum value
Mental demand	4350	22	225	0	400
Physical demand	215	1.1	0	0	105
Temporary requirement	5650	28.6	320	80	500
Performance	3955	20	150	40	475
Effort	3870	19.6	190	50	340
Frustration	1725	8.7	60	0	300
Total	19765	100	1087.5

NASA-TLX questionnaire (mental demand, physical demand, temporary requirement, performance, effort and frustration) in relation to the total mental workload: the answers are shown according to the mean, total score of all participants according to the dimension, percentage distribution, median, minimum and maximum values.

3.4 Level of perception of musculoskeletal discomfort in Master of Public Health students

According to the Nordic Questionnaire, it was reported that during the last 12 months and the last 7 days, 16 students (80%) presented musculoskeletal discomfort, and 4 students (20%) reported having no pain during this period. The presence of pain during the last 7 days was mainly in the neck (50%), lower back (40%), upper back (35%), and left shoulder (35%) (Table 4).

Table 4
Presence of pain in body areas in the last 7 days, according to the absolute frequency (n) and percentage distribution (%) (n = 20)

Variable Absolute frequency (n) Percentage distribution (%)

Neck 10 50^*

Right shoulder 4 20

Left shoulder 7 35

Right elbow/forearm 1 5

Left elbow/forearm 2 10

Right hand/wrist 6 30

Left hand/wrist 5 25

High Back 7 35

Low Back 8 40^*

Hips/Buttocks/Thighs 3 15

Knees 4 20

Ankles/Feet 4 20

Variable	Absolute frequency (n)	Percentage distribution (%)
Neck	10	50^*
Right shoulder	4	20
Left shoulder	7	35
Right elbow/forearm	1	5
Left elbow/forearm	2	10
Right hand/wrist	6	30
Left hand/wrist	5	25
High Back	7	35
Low Back	8	40^*
Hips/Buttocks/Thighs	3	15
Knees	4	20
Ankles/Feet	4	20

^*Body area with greater perception of musculoskeletal discomfort in the last 7 days.

4 Discussion

In this study, according to the results obtained, it was defined that it is essential to consider the multiple factors to which postgraduate students are exposed in the synchronous and asynchronous learning modality.

Working and studying add incredible difficulty to a person’s daily life due to the need to better organize the time to study, work, and contribute at home. Moreover, considering the COVID-19 pandemic, the dynamic of studying and learning had to be modified, with teaching needing to be done online.

In the COVID-19 pandemic, one of the biggest challenges was the use of technology, as mentioned in Abbasi’s study, where “41% reported interference in e-learning due to network problems’’ [28].

This research shows that the total sample (n = 20) presents medium and high levels of mental workload, where time demand stands out as the predominant dimension of mental workload among master’s students in the pandemic context.

Most students present musculoskeletal complaints in the last 12 months and the previous seven days, with the neck and lower back being the areas with the highest frequency. This result aligns with international literature exposing a clear trend of more significant musculoskeletal discomfort or disorders in these body areas in university students [22], even implying a higher risk of presenting psychological pain for this cause [29].

Finally, most of the sample studied had medium or high levels of physical activity, a protective factor for students’ mental health [30]. However, most students spent more time sitting than being physically active. The latter result is directly related to the predominant mental workload dimension; the change in online pedagogical strategies may increase students’ mental and physical workload.

According to musculoskeletal discomfort and its prevalence, it may have its origin in several factors influencing completing the master’s degree. One of its causes may be the amount of time spent in front of the computer [18], increased time in a sitting position, and decreased physical activity presented by students with low physical activity [31]. According to the literature, studies that analyzed the effects of COVID-19 on musculoskeletal pain and physical activity in teleworking suggest that less physical activity may be associated with a higher prevalence of musculoskeletal pain. Therefore, the results are congruent with the literature [32], as most of the population has musculoskeletal discomfort that could negatively impact their academic context and quality of life.

Physical activity in students is prevalent. However, they spend more time sitting than performing physical activity. The literature indicates a direct relationship between stress and sedentary behavior in the context of COVID-19, concluding that these factors negatively affect students’ mental health and physical activity [8]. Other studies also reveal decreased physical activity during quarantine and altered eating habits [33]. Therefore, the relevance in the analysis of this dimension in students considering the context of life and thus being able to contribute to strategies involving health protection and physical activity.

It is relevant for people studying online not only to consider the academic aspects of the program but also to involve other aspects, which have been described in this study, such as the variables of mental workload and musculoskeletal discomfort. Abbasi concluded that students’ emotional and psychological aspects should be taken seriously [28].

4.1 Study limitations

This study is not without limitations. The first limitation is the sample size, so this study is considered a pilot study, as the results cannot be extrapolated to the population.

The second limitation is the distance mode of data collection and the length of the questionnaires, which could have influenced the interest in answering them and the limited time students had to combine work, study, and personal life.

Finally, another limitation is that self-administered surveys were used. The answers are subjective perceptions that may be influenced by different disturbing variables such as cultural issues, personal or family situations, or conditions of the environment where they studied: type of chair, quality of internet, among others, which may have influenced the perception of students when answering the questions posed.

5 Conclusions

The results of this study show that the weekly hours spent by students in a combination of study and work is high, which can lead to mental and musculoskeletal discomfort and influence the concentration or performance of the person. On the other hand, it could be exacerbated by the online study approach due to the COVID-19 pandemic.

Regarding the perceived mental workload of master’s students, this was mainly determined by the time factor, the perception of time pressure, and the pace of work, which has a negative impact [14]. Therefore, time management strategies may be necessary to help the individual’s quality of life and productivity at work and academic performance.

Despite being described in the literature as a protective factor, the level of physical activity performed by master’s students was not found to be a factor that influences the mental workload of the student in the present study. However, the upper limbs’ static sitting and forced posture could negatively impact the perception of musculoskeletal discomfort.

The different teaching modalities (face-to-face or online) should be considered when elaborating didactic and curricular strategies while assessing the impact on the student’s health and promoting physical and mental health prevention. In addition, it is recommended to consider other variables that are fundamental pillars of some universities’ strategic guidelines to encourage their students’ self-care, such as those presented by the European Union in its CHRODIS+study strategy [34]. Finally, the future lines of study should be developed assuming that distance learning will continue to be part of the higher education teaching approach, especially in postgraduate programs.

Ethical considerations

The study protocol for this research was approved by the Human Research Ethics Committee of the Faculty of Medicine of the University of Chile (CEISH) (N° 238-2020 in the minutes N°202 of April 20, 2021). After being informed of the objectives of this research, all participants agreed to participate voluntarily once they had read the informed consent form and consented to participate by completing the electronic survey, which was coded to ensure the confidentiality of personal data.

Footnotes

Acknowledgments

The authors express their sincere gratitude to the coordinator of the master’s in public health at the University of Chile, Dra. Olivia Horna Campos, for her management and support in the recruitment process. In addition, thanks to the Postgraduate Academic Coordinator of the School of Public Health of the University of Chile and the Coordinator of Academic Management of the School of Public Health of the University of Chile, who was instrumental in the initiation of the research, and to the students of the master’s in public health who voluntarily agreed to participate in the study.

Conflict of interest

The authors have no conflicts of interest to report.

Funding

The authors have no funding to report.

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