Investigation of the multi-component ergonomics intervention effects on improving musculoskeletal outcomes and speech communication: A case study in open-plan offices

Abstract

BACKGROUND:

Office workers are at high risk of developing musculoskeletal symptoms (MSS) due to improper workstations. Open-plan bank office employees must communicate with bank clerks properly and perform financial activity precisely, but noise is a factor that disrupts their communication. Therefore, MSS and annoying noise are two of the main problems in open-plan offices.

OBJECTIVE:

This study evaluated the effects of a multi-component intervention involving individual (employee ergonomics training) and physical (improvements in workstation design and work environment) ergonomic factors on musculoskeletal outcomes and speech communication in open-plan environments.

METHODS:

A preliminary survey was carried out to investigate the overall ergonomics problems, the tasks and time analysis, workstations setup, the prevalence of MSS (Nordic Musculoskeletal Questionnaire), physical discomfort (Visual Analogue Scale [VAS]), and posture (assessed by Rapid Upper Limb Assessment [RULA] method), environmental status (measurement of noise), and speech intelligibility (assessed by Speech Interference Level [SIL] method based on ISO 9921). The multi-component interventions were performed afterward based on the data collected. A baseline assessment and a 9-month follow-up assessment were conducted.

RESULTS:

The results showed a significant decrease in the prevalence of musculoskeletal complaints (shoulders, elbows, and low back), physical discomfort, and awkward working postures after the intervention. A considerable improvement was also found in speech intelligibility post-intervention. The post-intervention questionnaire survey also indicated that employees generally favored the redesigned workstations.

CONCLUSION:

The results support the effectiveness of implementing multi-component interventions in open-plan bank offices to improve musculoskeletal complaints and speech communication.

Keywords

Ergonomics training posture office worker musculoskeletal symptoms redesign

1 Introduction

Several work-related and environmental factors influence employees’ health, well-being, and performance in almost all working environments [1, 2]. Musculoskeletal symptoms (MSS) include discomfort, pain, ache, burning, numbness, and tingling in different parts of the body and are based on subjective reports [3, 4], have been recognized as a consequence of exposure to various stressors such as awkward postures, repetitive movements, forceful exertions, and localized mechanical stresses [5].

The number of reported work-related musculoskeletal disorders in 2011 was 33% of all injuries and illnesses [6]. Other research shows this to be the case in other parts of the world, such as Europe and Asia [7, 8].

Office workers are one occupational group at high risk for developing MSS, which may be attributable to several risk factors, including frequent awkward working positions, placing the mouse and keyboard in the wrong place, improper workstations and chairs, and long-time work hours [9 –12]. In addition, a fundamental issue of interaction between employees and their surrounding environment should also be considered. The impact of environmental ergonomics factors on employees’ comfort, satisfaction, performance, productivity, safety, and health has been well documented in the literature [1 , 14].

There is also evidence that environmental stressors, such as office noise, have a considerable impact on job satisfaction, cognitive performance, health, and the performance of employees [1, 14].

The majority of office workers work in open-plan offices. Open-plan offices are minimal spatial separation. There are no walls up to the ceiling or doors in the interior of these offices, and they usually have a cubicle design; In these offices, employees are placed close to each other and can be easily visible and audible [15, 16]. Many studies have mentioned some advantages of this office design, such as improved communication and relationship between colleagues and team members, cost and energy efficiency, collegial atmosphere, and ease to question from their near co-workers [17, 18]. Contrary to the mentioned advantages, open-plan offices cause loss of concentration, lack of privacy, limited personal space, fatigue, lead to mistakes, auditory distraction, and unsafe noise [16 , 20].

From another point of view, studies that investigated MSS among employees who work in open-plan offices have reported a high prevalence of MSS among them [21, 22]. Some studies investigated the effect of physical environmental factors on MSS, and they showed that low-intensity noise inside offices increases the possibility of prevalence of MSS, especially in the head and neck, upper limbs, and low back. One of the reasons for this might be that employees in these environments pay less attention to adjusting workstation components such as chairs and footrests due to noise as a source of stress and other complaints from their environment [23 –26].

In open-plan bank offices, employees must communicate with bank clerks and perform financial activity precisely, but some office environmental aspect like the increased noise, improper workstations, and lack of privacy affect their health and performance [27, 28]. Despite the high prevalence of MSS and the adverse effects of office noise on employees [14], Our country’s banks have become increasingly open-planed. Some studies in our country investigated open-plan bank offices without implementing interventions; they have not considered interventions for the effects of both noise and workstation on speech communication and musculoskeletal outcomes, but they have given recommendations for acoustic and workstation design [27, 29].

Previous studies have established ergonomic interventions in offices, such as workstation adjustments, chair intervention, forearm support, exercise, and employee ergonomics training as practical tools to improve the working condition of employees [30 –34]. Several studies report that workstation design and postural interventions can reduce or prevent MSS [30 , 36], while others have found no significant improvement [31, 33]. In addition, although noise in open-plan offices is a cause of distraction and complaint, few studies manipulate it to control noise [37]. Due to the effects of noise on health, there is a need for studies that perform objective and subjective measurements of noise and control this issue by using some design features such as sound absorbers and partitioning [2].

Therefore, following the principles and evaluations of ergonomics for a safer design of open-plan offices, good technical design, assessing the needs of employees and their work requirements, and training people to adjust their workstations and rest during work time to prevent MSS, as well as training to reduce noise and the workplace acoustic comfort help organizations reducing the negative consequences related to the work environment and obtaining more favorable results [17 , 39].

According to the literature review, there is a high prevalence of MSS and noise annoyance in open-plan bank offices. This gave us three questions for our study: 1) how is it possible to reduce physical discomfort and MSS in an open office bank? 2) can environmental improvements and workstation redesign simultaneously improve speech communication? Furthermore, 3) how can we solve the bank employees’ ergonomics problems through an intervention ergonomics program? Therefore, this study set out to investigate the impact of a multi-component ergonomic intervention, including physical ergonomic factors (through improvements in workstation design and work environment) and individual (employee ergonomics training), on MSS risks and speech communication among bankemployees.

2 Methods

2.1 Study design, setting, and participants

This descriptive, analytical and interventional study was performed for 12 months from September 2017 to September 2018. Twenty-four workstations (representing the workspaces of 24 male bank employees) at three different open-plan bank offices were selected for the study. A total of 24 bank employees in the selected branches at the time of the study, were included. The bank employees communicated directly with clients and provided financial services to them. The inclusion criteria for the study were more than one year of working experience and having no previous history of musculoskeletal injuries and hearing problems (by self-report).

The dimensions and building characteristics of the bank branches where the intervention was performed were not the same. In general, they were all on the ground floor; before the interventions, their floors were made of marble, the walls made of marble up to an average of 120 cm, and the average plastered height was 210 cm. there were no installed sound absorbers in the walls and ceilings. There were, on average, 12 seats for customers in the waiting area. The causes of noisy environments inside the banks were the crowd of customers, the conversations of employees, equipment, and outside the banks. The equipment essential for employees’ work included a monitor, mouse, keyboard, printer, counterfeit detector machine, paper, money counting machine, and others. None of the workstations had footrests. The chairs were adjustable in height, but three needed to replaced.

A questionnaire was designed to gather demographic, job factors, and workstation setup information. The Nordic Musculoskeletal Questionnaire (NMQ) for musculoskeletal symptoms [40] and a VAS scale (0–10) with a body map for measuring physical discomfort. Working postures of the employees during their work were evaluated by using the Rapid Upper Limb Assessment (RULA) method [41]. These were performed using the video recordings taken from the study participants at their workstations during their work time. Observations and interviews were also used for the task and timeline analysis [42]. In this study, the anthropometric dimensions of employees did not directly measure. We derived these dimensions based on the data of Sadeghi et al. [43] and calculated the sizes of the new workstations.

Finally, the Speech Interference Level (SIL) method (ISO 9921, 2003) was used for the evaluation of speech communication and speech intelligibility. For evaluating the comfortability of a face-to-face conversation and using the SIL method need to exist in some conditions, including direct and face-to-face communication and a noisy environment [44]; In our study, there were these conditions at workstations. Therefore, this condition allowed us to evaluate the effectiveness of workstations on speech communication by the SIL method. The study parameters described above were evaluated pre- (baseline) and post- (9 months follow-up) intervention.

All participants, before their participation, signed a consent form. Each participating employee assigned their unknown identification number to the questionnaire for future monitoring and was familiarised with the study procedure. The investigator answered any questions before the study. The bank employees were told that the participation is voluntary and that they are voluntary complete the study. An ethical review committee of the Hamadan University of Medical Sciences (UMSHA.REC.1394.5) reviewed and approved the study protocol.

2.2 Task analysis and description

Task and timeline analyses were used as a flow analysis tool to know all of the tasks done by employees and estimate the order and duration of main functions performed by the bank employees [42]. Task analysis revealed two kinds of bank employees working in the studied banks: 1) bank staff performed administrative and computing tasks, prepared clients’ documents, and registered documents on government systems. 2) bank tellers were sitting all the time during the shift work and handled clerk requests. Twelve bank employees and twelve bank tellers were included in this study (N = 24). Despite the difference in job titles, the primary employee’s responsibilities including financial, administrative, and computing, were similar in task and timelineanalysis.

Timeline evaluation is a technique that combines functions or tasks with time-related data and is used to decide the order in which tasks are to be carried out and to estimate the quantity of time that will be taken to operate them [42]. Video recording, observations, and interviews with employees were used to analyze tasks and time during the shift and gave an overview of their ergonomic challenges. The results of the timeline analysis showed that in the first 30 minutes of the workday, the employees performed tasks in standing and walking positions. They prepared devices, papers, and money for starting a work day. On average, for 330 min (68.75% of the shift time), they were sitting at their workstations, fulfilling the bank clerk’s requests and communicating them. They had a maximum of 30 min of rest for the whole workday. Another task was finalizing the accounts (18.75% of the shift, 90 min); at this time, there was no bank clerk, and employees were sitting and working on their computers at their workstations. The bank employees performed nearly all of their tasks in a sitting position (87.5% of shifts). Therefore, sitting postures were selected for posture analysis by the RULA method.

Before the intervention, bank clients were standing in front of the counters, and employees must extend their necks and shoulders to converse and exchange documents. Customers’ speech and waiting were the leading cause of the crowd inside the bank. Many waiting clients standing in front of the employee made the employee feel pressured. Therefore, a customer at the new workstation must sit in front of the employee, and the employee could only do the service one person at a time. So, through design, we canalized customers’ behavior to sitting in front of employees.

Employees also had to work without enough breaks for a long time. There was not enough legroom for employees, and limited space was available over the desk for work items and for performing work tasks. The layout of monitors and functional objects (chair, keyboard, currency counting machine, mouse, printers) was also inappropriate (Fig. 1). This situation made it difficult for employees and clients to communicate effectively and forced them to adopt awkward postures during their work.

Fig. 1

Typical examples of workstations before the intervention.

The results of the analysis of the interviews showed that the main problems of bank employees include: Neck pain, low back pain, static shoulder tension while making customer requests, lack of rest, difficult communications due to speech interference, lack of legs clearance, lack of space on the table, lack of office ergonomics training, and lack of concentration resulted from loud noise. These problems were divided into three categories, and interventions were carried out in these three areas: 1) Musculoskeletal symptoms, 2) environmental problems, and 3) training.

2.3 Intervention

The results of task analysis and noise measurements provided essential insights to develop the multi-component intervention which aims to prevent or reduce musculoskeletal problems, reduce contributing MSS risk factors, and improve speech intelligibility in the office workplace. Thus, the intervention program focused on three components:

Workstation and environmental redesign (based on anthropometric considerations for proper configuration of monitors, placement of objects or working items within appropriate reach zones, provision of adequate leg clearance, and provision of footrests as necessary).

Improving speech intelligibility and distance between employees and bank clerks.

Improving employees’ ergonomics knowledge through training.

The following sections describe the interventions in more detail.

2.3.1 Redesign of workstations

The required anthropometric data for redesigning workstations were derived from the relevant anthropometric databases of the Iranian working population [43]. Based on the recommendations in the literature, we derived 18 dimensions data, including elbow height-sitting, sitting height, elbow-fingertip length, foot length, and forward grip reach, along with others; to calculate workstation proportions, including table height, thigh clearance, lateral and forward legroom, the height of workstation, and others [45, 46]. Figures 2a and 2b show the shape and size of the redesigned workstations. Table 1 presents and describes the anthropometric dimensions and criteria used for redesigning workstations. We changed some features of the workstation to reduce physical discomfort and increase privacy e.g., reducing the forward accessible zone at the exchange document’s part to provide convenient reach, installing glass between employees, increasing the length and width of the desk to provide sufficient surface for working tools of employees, installing and increasing the height of glass between employee and client (redesigned workstation height was 165 cm), preparing sufficient forward, lateral and vertical legroom, etc. The redesigned workstations were not adjustable in height. Figure 3 shows an illustration of the installed workstations in bank branches after interventions.

Fig. 2

The shape (a) and size (b) of the redesigned workstation.

Fig. 3

An illustration of the redesigned workstations.

Table 1

Anthropometric dimensions and criteria used for re-designing the workstations

Dimensions	Criterion (percentile)	Application(s)
Elbow height - sitting	50th	Determination of work surface
Eye height - sitting	50th	Placement of monitors, face-to-face communication with clients
Knee height	95th	Determination of required clearance beneath the underside of the desk
Thigh thickness	95th	Determination of required clearance between the seat and the underside of the desk
Buttock-knee length	95th	Determination of required clearance between seat back and obstacles in front of the knee
Elbow-fingertip length	5th	Determination of normal working area
Shoulder-grip length	5th	Determination of zone of convenient reach
Span	95th	Determination of lateral reach in the workspace
Elbow span	95th	Determination of elbow room in the workspace
Foot length	95th	Determination of clearance for foot

The previous workstations of the three branches were not the same. In general, after redesigning the tables; the height (from an average of 78 to75 cm) and the thickness (from 7 cm to 3 cm) decreased; the length (from an average of 110 cm to 150 cm) and the depth (from average 64 cm to 97 cm) increased. The height of the counter in front of the employee decreased (from an average of 50 cm to 25 cm).

Chairs are an essential part of the workstation; therefore, we examined the chairs as part of the intervention. Chairs were replaced if the height was not adjustable or their settings were damaged (N = 3). On the opposite side of the workstation, adjustable chairs (in height) were placed for customers to sit in front of the employees and communicate face-to-face.

2.3.2 Work environment improvement

This part of the intervention aimed to reduce the effects of office noise on speech communication; This was partly performed through workstation configuration, emphasizing improving face-to-face contact between employees and customers and using partitions between workstations. Other treatments included using sound-absorbing materials on ceilings (e.g., perforated acoustic plasterboard tiles) and wall covering materials (e.g., MDF and PVC construction materials) to reduce environmental noise. Increasing the number of circle small holes in the glass from six to twelve and reducing their height in front of the bank clerk’s mouth improve verbal communication. The employee got closer to the client by the forward arc in the desk, and the distance between them shortened than before [47].

2.3.3 Ergonomics training

The results of the timeline analysis indicated that bank employees had a long duration of sitting work without breaks, along with frequent bending and twisting motions at their workstations. Thus, ergonomics training was meant to improve employees’ working postures and habits. Training consisted of three 60-min sessions conducted by the first author, who was qualified in ergonomics training. During the training sessions, participants were instructed to adjust their workstations to avoid musculoskeletal problems. Through the training sessions, we taught employees to how to adjust their chairs, use the footrest after adjusting the height of the chair according to the person’s and workstation height if the feet are not on the floor, not sit on the edge of the chair, lean on the backrest while working, change their posture during the work, and others.

The participants also received a training booklet about office ergonomics, MSS and their potential risk factors, work postures, workstation adjustments, and workplace exercise/rest breaks at the end of the training sessions. A poster was installed in the break room so that it read during break time. The same author performed follow-up visits to encourage participants to follow the instructions in three sessions face to face training.

2.4 Outcome measures

A short questionnaire was designed to ascertain the participants’ demographic and job information (including age, weight, height, marital status, educational degree, making regular sport/exercise, smoking habits, work experience as a bank employee, the time of work per day, the time of sitting position per day, duration of continuous work without a break (>15 min), number of customers served per day, working overtime and receiving ergonomic training before our study), and to gain information on the opinions about the workstation setup (e.g., enough space for work items or doing work tasks, monitor position, monitor height, monitor distance, adequate legroom, forearm support, lower arm position, adjustable backrest, thigh support, adjustable chair height, satisfaction with workstation setup).

The musculoskeletal symptoms during the last seven days in nine different body regions were measured using the NMQ [40]. The severity of physical discomfort was also measured using a rating scale from 0 = no discomfort to 10 = unbearable discomfort together with a body map.

The RULA method is a reliable and validated observational posture analysis tool that assesses the working postures of bank employees at their workstations [41]. The analysis of working postures was performed using the video recordings taken from the study participants at their workstations during their work time. The revised Persian version of this tool, with acceptable reliability and validity, was used [48].

We used the standard ISO 9921:2003 for assessing speech communication and considered person-to-person communication in the bank office. The SIL (Speech Interference Level) and speech interference level of noise (L_SIL) was calculated at the listener’s position to determine the appropriate distance between speaker and listener and speech intelligibility in new workstations. According to ISO 9921 [49], fair speech-communication intelligibility is ensured if SIL = L_S,A,L - L_SIL is ≥10 dB at the listener’s position. For this, the SIL values use to rate speech intelligibility as bad (<3 dB), poor (3 to 10 dB), fair (10 to 15 dB), good (15 to 21 dB), and excellent (21 dB).

A sound level meter (Casella CEL-450), calibrated with a CEL-110/2 calibrator, was used for this purpose. Two measurements were made for each workstation (N = 48 measurements) for 15 minutes during rush working hours (from 10:00 a.m. to 1:00 p.m.), and frequency analysis and related calculations were subsequently performed based on ISO 9921 (2003). Also, the employees were asked a question to determine whether they could hear the customer’s voice clearly when they talked; “when you listen to your customer, can you hear his/her voice clearly?” The response was yes or no.

2.5 Data analysis

Data management and analysis were performed using SPSS 16.0 (SPSS Inc., Chicago, IL, USA). Descriptive statistic was applied to obtain the percentage and frequency of answers to single questions about speech ineligibility and the prevalence of MSS. The McNemar test was used to compare the prevalence of MSS and employees’ perceptions of the workstation setup. In contrast, the Wilcoxon Signed-Rank test was used for comparing the mean score of discomfort, working postures (RULA scores), SIL, and L_SIL before and after the interventions. Mann-Whitney U test was applied to evaluate the relationship between physical discomfort and MSS in the body’s organs. Statistically significant values for all statistical analyses were considered of p < 0.05.

3 Results

3.1 Demographic and job details

Table 2 presents the demographic and job characteristics of bank employees. Participants were all male, with a mean age of 39.0 (6.7) and a mean of work experience of 15.6 (6.1) years, and most were married 23 (95.8%). Nine of the participants’ education status was a diploma (37.5%), and eleven were undergraduate degrees (45.8%). A large number of the participants indicated that they spent their working time in a sitting position for more than seven hours (16 people (66.6%)), and 22 people had frequent periods of continuous work (more than two hours) without a break (>15 min) during a daily shift (91.6%). The percentage of employees who provided services to more than 60 bank customers was 45.8%. Most employees indicated that they had received no ergonomic training (22 people (91.6%)).

Table 2
Demographic and job details of the bank employees

Variables

Age (years)

Mean (SD) 39.0 (6.7)

Range 31–52

Body mass index (BMI) (kg/m²)

Mean (SD) 26.2 (3.5)

Range 25.5–32.1

Marital status (n (%))

Single 1 (4.1)

Married 23 (95.8)

Education (n (%))

Diploma 9 (37.5)

Undergraduate 11 (45.8)

Postgraduate 4 (16.6)

Regular physical activity (n (%))

Yes 10 (41.6)

No 14 (58.3)

Smoking (n (%))

Yes 4 (16.6)

No 20 (83.3)

Worked as a bank employee (years)

Mean (SD) 15.6 (6.1)

Range 6–27

Daily working time (hours)

≤8 18 (75.0)

>8 6 (25.0)

In a sitting position per day (hours) (n (%))

4–6 h 8 (33.3)

7–8 h 13 (54.1)

>8 h 3 (12.5)

Continuous work without break (>15 min) (n (%))

<1 h 2 (8.3)

1-2 h 2 (8.3)

>2 h 20 (83.3)

Number of customers served per day (n (%))

<20 4 (16.6)

20–60 9 (37.5)

>60 11 (45.8)

Received office ergonomic training (n (%))

Yes 2 (8.3)

No 22 (91.6)

Variables
Age (years)
Mean (SD)	39.0 (6.7)
Range	31–52
Body mass index (BMI) (kg/m²)
Mean (SD)	26.2 (3.5)
Range	25.5–32.1
Marital status (n (%))
Single	1 (4.1)
Married	23 (95.8)
Education (n (%))
Diploma	9 (37.5)
Undergraduate	11 (45.8)
Postgraduate	4 (16.6)
Regular physical activity (n (%))
Yes	10 (41.6)
No	14 (58.3)
Smoking (n (%))
Yes	4 (16.6)
No	20 (83.3)
Worked as a bank employee (years)
Mean (SD)	15.6 (6.1)
Range	6–27
Daily working time (hours)
≤8	18 (75.0)
>8	6 (25.0)
In a sitting position per day (hours) (n (%))
4–6 h	8 (33.3)
7–8 h	13 (54.1)
>8 h	3 (12.5)
Continuous work without break (>15 min) (n (%))
<1 h	2 (8.3)
1-2 h	2 (8.3)
>2 h	20 (83.3)
Number of customers served per day (n (%))
<20	4 (16.6)
20–60	9 (37.5)
>60	11 (45.8)
Received office ergonomic training (n (%))
Yes	2 (8.3)
No	22 (91.6)

3.2 Musculoskeletal symptoms

Table 3 illustrates the prevalence (in the last seven days) and the severity of physical discomfort among the participants before and nine months after the intervention. The most frequent body areas affected among the employees at pre-intervention were the shoulders (66.6%), low back (61.9%), and neck (41.6%). Twenty employees (83.3%) reported some musculoskeletal symptoms at baseline, which reduced to 14 employees (58.3%) after the intervention. A comparison of the pre-and post-intervention results reveals significant differences between the prevalence of symptoms in some parts of the body, so the prevalence rates of elbows (p < 0.05), low back (p < 0.01), and shoulders (p < 0.05) symptoms were lower after the intervention than before. In most body regions, the mean rating of physical discomfort was moderate before the intervention (4 or 5 on a scale of 0–10), which generally reduced to low after the intervention (2 or 3 on a scale of 0–10). This result was significant at the p = 0.05 level. Physical discomfort in the neck, shoulders, low back, hips/thighs/buttocks, and knees was more significant than in the group without symptoms of MSS (P < 0.05), Table 4 shows the results.

Table 3
Prevalence of MSS and physical discomfort among participants pre- and post-interventions

Body region Prevalence of symptoms, N = 24 Physical discomfort (Scale 0–10), N = 24

Pre-intervention Post-intervention P-value^a Pre-intervention Post-intervention P-value^b

n (%) n (%) Mean (SD) Mean (SD)

Neck 10 (41.6) 6 (25.0) 0.12 5.6 (3.2) 4.6 (2.4) 0.01

Shoulders 16 (66.6) 6 (25.0) 0.02 4.9 (3.0) 3.8 (2.0) 0.03

Elbows 8 (33.3) 2 (8.3) 0.03 3.7 (2.3) 1.5 (1.0) 0.001

Hands/wrists 6 (25.0) 3 (12.5) 0.25 3.0 (2.3) 2.0 (1.4) 0.01

Low back 16 (66.6) 9 (37.5) 0.01 5.4 (2.9) 3.3 (2.0) 0.001

Hip/thighs/buttocks 7 (29.16) 2 (8.3) 0.06 4.2 (3.0) 2.9 (1.9) 0.01

Knees 8 (33.3) 3 (12.5) 0.06 3.4 (1.1) 2.5 (0.5) 0.06

Ankles/feet 4 (16.6) 2 (8.3) 0.50 4.5 (3.5) 2.0 (1.5) 0.001

Total 20(83.3) 14(58.3) 0.011 4.4(2.6) 2.8(1.6) 0.001

Body region	Prevalence of symptoms, N = 24	Physical discomfort (Scale 0–10), N = 24
Neck	10 (41.6)	6 (25.0)	0.12	5.6 (3.2)	4.6 (2.4)	0.01
Shoulders	16 (66.6)	6 (25.0)	0.02	4.9 (3.0)	3.8 (2.0)	0.03
Elbows	8 (33.3)	2 (8.3)	0.03	3.7 (2.3)	1.5 (1.0)	0.001
Hands/wrists	6 (25.0)	3 (12.5)	0.25	3.0 (2.3)	2.0 (1.4)	0.01
Low back	16 (66.6)	9 (37.5)	0.01	5.4 (2.9)	3.3 (2.0)	0.001
Hip/thighs/buttocks	7 (29.16)	2 (8.3)	0.06	4.2 (3.0)	2.9 (1.9)	0.01
Knees	8 (33.3)	3 (12.5)	0.06	3.4 (1.1)	2.5 (0.5)	0.06
Ankles/feet	4 (16.6)	2 (8.3)	0.50	4.5 (3.5)	2.0 (1.5)	0.001
Total	20(83.3)	14(58.3)	0.011	4.4(2.6)	2.8(1.6)	0.001

^aMcNemar test. ^bWilcoxon Signed Rank test.

Table 4

Relationship between Physical discomfort and prevalence of MSS in each body region

Body region	Prevalence of symptoms	N	Physical discomfort	P-value^a
			Mean (SD)
Neck	yes	10	8.3 (1.8)	0.01
	no	14	3.6 (2.5)
Shoulders	yes	16	6.0 (2.5)	0.008
	no	8	2.5 (2.3)
Elbows	yes	8	4.2 (1.9)	0.41
	no	16	3.3 (2.4)
Hands/wrists	yes	6	4.2 (2.3)	0.23
	no	18	2.6 (2.1)
Lower back	yes	16	6.6 (2.5)	0.04
	no	8	3.4 (2.9)
Hip/thighs/buttocks	yes	7	7.6 (3.2)	0.01
	no	17	2.1 (1.7)
Knees	yes	8	7.2 (2.6)	0.003
	no	16	2.7 (2.0)
Ankles/feet	yes	4	8.0 (3.4)	0.15
	no	20	3.7 (3.0)

^aMann-Whitney U test.

3.3 Working postures

The results of posture analysis by RULA scores have shown in Table 5. at baseline, the mean of score A (wrist/arm score) was 5.5 (SD = 1.3), and the mean of score B (neck/trunk/leg score) was 5.6 (SD = 2.1). The posture scores A (mean = 3.2; SD = 0.6) and B (mean = 2.5; SD = 0.3) were significantly reduced at post-intervention (p < 0.01). The overall mean RULA grand score at baseline was 6.0 (SD = 1.4) (action level was three), which means most workstations needed an investigation and modifications soon. The overall mean RULA grand score was significantly (p < 0.01) decreased post-intervention (mean score was 3.1; action level was two).

Table 5
Distribution of RULA scores for the study participants

Pre-intervention Post-intervention P-value^a

Min-Max Mean (SD) Min-Max Mean (SD)

Upper arms 1–5 4.2 (1.3) 1–3 2.7 (0.6) 0.010

Lower arms 1–3 2.5 (0.6) 1-2 1.8 (0.3) 0.007

Wrists 1–3 2.4 (0.6) 1-2 1.4 (0.5) 0.006

Neck 2–5 4.2 (1.2) 1–3 2.0 (0.4) 0.004

Trunk 1–3 2.0 (0.6) 1-2 1.7 (0.4) 0.180

Legs 1-1 1.0 (0.0) 1-1 1.0 (0.0) 1.000

A score 3–7 5.5 (1.3) 2–4 3.2 (0.6) 0.003

B score 2–7 5.6 (2.1) 2-3 2.5 (0.3) 0.004

Grand score 3–7 6.0 (1.4) 2-3 3.1 (0.3) 0.003

	Pre-intervention	Post-intervention	P-value^a
Upper arms	1–5	4.2 (1.3)	1–3	2.7 (0.6)	0.010
Lower arms	1–3	2.5 (0.6)	1-2	1.8 (0.3)	0.007
Wrists	1–3	2.4 (0.6)	1-2	1.4 (0.5)	0.006
Neck	2–5	4.2 (1.2)	1–3	2.0 (0.4)	0.004
Trunk	1–3	2.0 (0.6)	1-2	1.7 (0.4)	0.180
Legs	1-1	1.0 (0.0)	1-1	1.0 (0.0)	1.000
A score	3–7	5.5 (1.3)	2–4	3.2 (0.6)	0.003
B score	2–7	5.6 (2.1)	2-3	2.5 (0.3)	0.004
Grand score	3–7	6.0 (1.4)	2-3	3.1 (0.3)	0.003

^aWilcoxon Signed Rank test.

3.4 Speech communication

The mean distance between employees changed from 95 cm to 115 cm, and between clients and employees changed from 123 cm to 103 cm [47]. At post-intervention, the mean (SD) L_SIL was significantly decreased (from 59.9 (4.9) dB to 55.1 (5.2) dB, p < 0.001), while the mean SIL was significantly increased (from –1.6 (3.9) to 4.1 (4.9), p < 0.001). At pre-intervention, 16 of 24 workstations were determined as “Bad,” seven workstations were “Poor,” and one were “Fair” speech intelligibility. After environmental improvement, nine were “Bad,” 10 were “Poor,” four were “Fair,” and one was “Good” speech intelligibility. Before the intervention, seven employees (29.1%) stated that they could hear the customers’ voices clearly, which increased to 18 employees (75.0%) after the intervention. This difference was statistically significant at the P = 0.05 level.

3.5 Employees’ assessment of the workstation setup

Only five (20.8%) of the respondents were generally satisfied with their workstation setup at pre-intervention, which was significantly increased to 22 people (91.6% (p < 0.001)) after the intervention (Table 6). Compared to pre-intervention, significantly higher percentages of employees believed that the redesigned workstation provided more space for work items or doing work tasks (p < 0.001), appropriate elbow support (p < 0.001), neutral lower arm position (p < 0.05), and monitor height (p < 0.001).

Table 6
Employees’ assessment of their workstation’s setup before and after the intervention

Workstation set up Pre-intervention Post-intervention P-value^a

Yes n (%) Yes n (%)

1. Is there enough space on the desk for work items? 6 (25.0) 17 (70.8) 0.001

2. Is there enough space on the desk to do work tasks? 4 (16.6) 16 (66.6) 0.001

3. Are the work items within your normal reach without having to bend or twist your body? 12 (50.0) 16 (66.6) 0.125

4. Is the visual display (monitor) placed directly in front of you? 11 (45.8) 15 (62.5) 0.125

5. Is the top of the monitor placed at eye level? 7 (29.1) 18 (75.0) 0.001

6. Is the monitor positioned at arm’s length away? 10 (41.6) 20 (83.3) 0.002

7. Is there sufficient legroom under the workstation? 13 (54.1) 18 (75.0) 0.063

8. Can you rest your forearms on the desk/desktop? 8 (33.3) 22 (91.6) 0.001

9. Can you keep your lower arms parallel to the desk while using the keyboard or mouse? 7 (29.1) 15 (62.5) 0.008

10. Is your back supported by the chair’s backrest? 7 (29.2) 14 (58.3) 0.016

11. Does the chair provide thigh support? 9 (37.5) 16 (66.6) 0.016

12. Is your chair height adjusted so that your feet are flat on the floor (or on a footrest)? 10 (41.6) 24 (100) 0.001

13. Are you generally satisfied with the workstation setup? 5 (20.8) 22 (91.6) 0.001

Workstation set up	Pre-intervention	Post-intervention	P-value^a
1. Is there enough space on the desk for work items?	6 (25.0)	17 (70.8)	0.001
2. Is there enough space on the desk to do work tasks?	4 (16.6)	16 (66.6)	0.001
3. Are the work items within your normal reach without having to bend or twist your body?	12 (50.0)	16 (66.6)	0.125
4. Is the visual display (monitor) placed directly in front of you?	11 (45.8)	15 (62.5)	0.125
5. Is the top of the monitor placed at eye level?	7 (29.1)	18 (75.0)	0.001
6. Is the monitor positioned at arm’s length away?	10 (41.6)	20 (83.3)	0.002
7. Is there sufficient legroom under the workstation?	13 (54.1)	18 (75.0)	0.063
8. Can you rest your forearms on the desk/desktop?	8 (33.3)	22 (91.6)	0.001
9. Can you keep your lower arms parallel to the desk while using the keyboard or mouse?	7 (29.1)	15 (62.5)	0.008
10. Is your back supported by the chair’s backrest?	7 (29.2)	14 (58.3)	0.016
11. Does the chair provide thigh support?	9 (37.5)	16 (66.6)	0.016
12. Is your chair height adjusted so that your feet are flat on the floor (or on a footrest)?	10 (41.6)	24 (100)	0.001
13. Are you generally satisfied with the workstation setup?	5 (20.8)	22 (91.6)	0.001

^aMcNemar test.

4 Discussion

The present study was designed to determine the effect of a multi-component ergonomic intervention involving workstation redesign, work environment improvement concerning office noise, and employee ergonomics training on MSS risks and speech communication among office workers according to analyzing employees’ workplace problems.

One of the main findings was that the prevalence of MSS (particularly in the shoulders, low back, and elbows) considerably decreased after the intervention, and a significant change was found in the physical discomfort of all parts of the body pre-and post-intervention. The results also showed significant improvements in working postures (score of RULA A, RULA B, and RULA grand scores) and speech intelligibility. Additionally, the post-intervention questionnaire survey revealed that employees generally favored the redesigned workstations. The results of this study indicate the effectiveness of the implemented multi-component intervention. In this study, most employees had to sit for long hours without enough breaks. Most of them had not previously received training in ergonomics and workstation setup; These findings are in agreement with previous studies [11 , 50–52].

The current study found that the most prevalent MSS before the intervention were neck, shoulders, and low back. The high prevalence of spinal, shoulder, and neck symptoms found in the present study was also reported by other studies [11 , 22]. The findings from these studies highlight a relatively high prevalence of spinal pain among office workers who work at computer workstations, which is not surprising because their job requires frequent and prolonged forward bending of their bodies, especially the neck and trunk. This situation would be even worse because bank employees in this study had workstations that were not designed for their needs specifically. Such a working condition imposes excessive postural loading on the lumbar spine. It would, therefore, seem appropriate to adopt ergonomic interventions aimed at reducing biomechanical loads on the spinal structures. Ergonomic interventions based on workstation redesign and employees’ behavioral change through training can influence employees’ musculoskeletal health. The ergonomic interventions used in the present study are based on these two approaches. The results demonstrated that the symptoms’ prevalence (particularly elbows, shoulder, and low back) significantly reduced after the intervention. However, our study’s reduced frequency of symptoms generally agrees with the findings of Laestadius et al. [53]. The lack of significant differences in the prevalence of symptoms in other body parts is not supported by the previous reports [32 , 55]. These might be attributed to the different methodologies or protocols used in the various studies. From these findings, it concluded that commonly used ergonomic interventions aimed at preventing MSS through workstation configuration and employee ergonomics training; may have the potential to reduce the frequency of MSS.

Another point that should be noted is that MSS are known as multifactorial. Therefore, multiple-component interventions at both the employee and workplace levels may have a greater chance of success than single interventions [56, 57]. The results of the present study also confirm this view. Nevertheless, the possible effect of any single component may not be easily determined in multiple-component interventions [54, 58]; This is the case for the present study, were implementing a three-component intervention generally positively impacted the study outcomes (e.g., reduction of MSS and improvement in working postures).

The results of the present study showed that physical discomfort decreased after the interventions, which was expected because of redesigning the workstations. The employees were taught how to set up their workstations. These matched those observed in earlier studies performed by workstation interventions to reduce discomfort and the prevalence of MSS [34 , 59]. The present study also showed that physical discomfort has a significant relationship with the symptoms of MSS; these results agree with those obtained by other studies [60, 61]; accordingly, maybe after a long time, MSS decreases more than before, and this needs longer follow-up.

One unanticipated finding was that neck symptoms did not decrease significantly after the interventions, despite the decrease in physical discomfort, which could be due to the rotation of the neck angle to the computer after the interventions. The extension of the neck was removed after the intervention. However, face-to-face communication with the bank clerk was a constraint for putting the monitor in front of the employees and eliminating the neck rotation, which needs further investigation in the future.

These findings suggest that ergonomic interventions are generally associated with employees’ behavioral changes, so bank employees were to adopt more neutral arm, wrist, and neck postures. The RULA grand score was decreased from action level three to action level two as a consequence of the application of three types of intervention, confirming the effectiveness of the programs. To the present results, previous studies have demonstrated that improved working postures among office workers as a result of applying an ergonomics intervention, including ergonomics training and adjustable chair for office workers; it concluded that change in working postures has the potential to reduce the occurrence of MSS among office workers [34 , 62].

Our post-intervention questionnaire survey results revealed that most employees were satisfied with the intervention. Therefore, these findings highlight the importance of applying multiple interventions involving physical (e.g., workstation design based on anthropometric data in our study) and user experience [63].

Improvement in SIL was also considered part of this study’s intervention. After the intervention, most of the employees stated that they heard the voice of the bank clerk clearly. This is relevant to improving speech communication, the employee’s satisfaction, and concentration which can consequently influence the mood and cognitive performance of employees [1, 14]. Additionally, our findings indicated that approximately 20.83% of the workstations had “Fair” and “Good” speech intelligibility after the intervention. Although this shows a relative improvement in speech intelligibility, further development work may be needed to improve this situation. In this regard, some investigators have noted the positive effect of good room acoustic design on speech intelligibility, acoustic treatment, and extra partition in open-plan offices [64, 65]. Others have proposed a lower-cost solution, such as re-arranging the office layout to optimize the acoustic condition of the work environment [66]. Improvements in speech intelligibility can be due to components; such as increasing the height of the work position (165 cm), increasing the distance from other employees (115 cm), close to the customer (103 cm), as well as the use of sound insulation on the ceiling and other changes in the environment to reduce annoying noise inside the bank.

Therefore, in the present study, after identifying the major problems in the bank branches, we presented the solution to their problems in the form of a three-part ergonomic intervention program, including redesigning workstations, environmental changes, and training. The results were in the form of reduced MSS, decreased body discomfort, decreased awkward postures, and increased speech intelligibility.

4.1 Limitations and future work

The major limitation was that a small number of employees participated in this study due to the availability of bank branches in the study area and economic considerations. We acknowledge that the limitation of the small sample size and the absence of a control group may affect the generalisability of findings to other related ergonomic interventions and population groups. Notwithstanding these limitations, the study partially substantiates the advantages of the multi-component ergonomics interventions in office workstations and provides a basis for future work in other open-plan environments.

Validation and generalizability may require future studies with different occupational groups and more extended follow-up periods. Moreover, greater efforts are needed to determine the outcome variables objectively and the effects of a multi-component intervention on speech communication.

5 Conclusions

The present investigation is one of the first attempts to evaluate the effectiveness of a multiple-component ergonomic intervention, including employee ergonomics training, workstation redesign, and environmental ergonomics in Iran’s open-plan bank office work environments. Musculoskeletal complaints and awkward working postures were reasonably common among the bank employees, significantly decreasing after the intervention. Speech communication was also considerably improved as a result of the implementation of the intervention program. The usefulness of the implemented multi-component intervention seems to be verified by our results, but further investigation is recommended for generalisability and validation. The findings of this study have several important implications for suggesting that decision-makers consider ergonomics assessments when designing or improving open-plan bank offices.

Footnotes

Acknowledgments

The study was sponsored by Hamadan University of Medical Sciences in the form of a master’s degree dissertation (project no. 9404091976). The authors express their gratitude to all participants in the study.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Ethical approval was obtained from the Hamadan University of Medical Sciences (UMSHA.REC.1394.5).

Informed consent

Not applicable.

Funding

The authors report no funding.

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