Abstract
BACKGROUND:
Architecture students maintain uncomfortable body postures for hours while designing and constructing project models, putting them at high risk of developing musculoskeletal pain (MSP).
OBJECTIVE:
This research aimed to determine the prevalence of MSP among students at the Architecture and Planning College at King Saud University, Saudi Arabia.
METHODS:
This descriptive cross-sectional survey study used a self-administered online questionnaire. A total of 123 students (65 female) aged 19–25 years participated. The survey consisted of eight demographic and health status questions and the Extended Nordic Musculoskeletal Questionnaire (NMQ-E). The data were analyzed using descriptive statistics; Mann-Whitney U and chi-square tests were used to compare genders at α= .05.
RESULTS:
Approximately 94.3% of architecture students reported pain in at least one body region in the last 12 months, and 87.0% in the last seven days. The highest reported percentage of MSP was neck pain, followed by lower back pain. No differences in MSP were found between genders, except in elbow and hand pain for the last 12 months and elbow pain for the last seven days.
CONCLUSION:
There was a high prevalence of MSP among undergraduate architecture students, highlighting the need to prevent occupational health issues at an early stage.
Introduction
Musculoskeletal pain (MSP) refers to pain in the musculoskeletal system, such as in muscles, bones, ligaments, or tendons. It can be localized and present in one region of the body (for example, the neck, trunk, or upper and lower extremities), or it can be present in more than one area [1]. There are three main causes of musculoskeletal pain: musculoskeletal diseases, trauma, and abnormal stress and strain on muscles and soft tissues caused by poor posture, poorly designed seating, or incorrect bending and lifting motions, also known as work-related musculoskeletal disorders [2].
Musculoskeletal pain is relatively common among undergraduate students of health specialty, especially those students who often work in awkward positions, such as undergraduate students of nursing, physiotherapy, occupational therapy, medicine, and dentistry [3–7]. Many studies have explored the prevalence of MSP among health students and concluded that the prevalence was high, ranging from 58.8% to 96.0% [3, 4]. However, studies regarding non-health students are still limited, which is the case for Saudi architecture students.
A professional architect is trained in the science of building design. Their work involves developing concepts for structures and turning them into images and plans that are then used for buildings; construction approaches, computer-aided design, and drafting are all typically included in the architecture curriculum at the college level [8, 9]. Architecture students often maintain uncomfortable trunk, neck, and arm postures for long hours while designing and constructing project models, making them at high risk for developing MSP [9–11]. A previous study revealed that 78% of Nigerian architecture students complain of MSP, and this prevalence was comparable to the reports (76%) of physical therapy students [10].
Pain, with different levels of intensity, can affect daily living activities and cause disability, productivity loss, and a diminished quality of life, which can negatively affect academic performance and reduce productivity in one’s working life [12, 13]. In order to develop MSP prevention strategies, its prevalence needs to be understood among specific populations. To the best of the author’s knowledge, the prevalence of MSP among Saudi architecture students is unknown.
Therefore, the current study aimed to (1) explore the prevalence of MSP and (2) compare its extent between genders among undergraduate students in the Architecture and Planning College (Architecture and Building Sciences Program) at King Saud University (KSU), Riyadh, Saudi Arabia (SA).
Materials and methods
Study design and setting
The research utilized a descriptive, cross-sectional study. Data were collected using a self-administered online survey completed by architecture students between January and March 2023.
Participants
Undergraduate students, both male and female, in the Architecture and Planning College of KSU who completed the first preparatory year were eligible to participate in the study. A convenience sampling method was used to select the participants. Students who reported musculoskeletal injuries, surgery, or other musculoskeletal disorders prior to enrollment in the university were excluded.
The sample size to estimate prevalence was calculated with a precision of 0.08 (based on the high prevalence reported by previous research [10, 14]) and 95% confidence [15]. Based on the architecture and planning college’s most recent annual report [16], the number of students enrolled in the architecture and building sciences program was 484. The minimum sample size was determined using the finite sample size formula, n = N/(1 + N(e)2), where n = minimum sample size required, N = total number of students, and e = precision [17]. Thus, a minimum sample of 119 students was required. A valid response rate needed to be at least 24% across the identified student population to achieve the required sample.
Research instrumentation
A self-administered online survey was used in the study. The survey contained two parts. The first part consisted of five questions related to the demographic characteristics (age, gender, height, weight, and academic level), and three questions related to previous health (musculoskeletal disorders). The second part measured the prevalence of musculoskeletal pain using the Extended Nordic Musculoskeletal Questionnaire (NMQ-E).
The NMQ-E is a reliable and valid instrument that consists of 36 questions on musculoskeletal symptoms regarding nine regions of the body (neck, shoulder, upper back, elbows, wrists/hands, lower back, hips/thighs, knees, and ankles/feet). For each body region, there are four questions to assess: the prevalence of pain during the last 12 months and the last 7 days, if normal activity was restricted due to pain, and if the respondent sought medical help [18]. A picture of a body illustrating the nine body regions assessed by the NMQ is provided in this section.
Ethical consideration and informed consent
Ethical approval was obtained from the Institutional Review Board of King Saud University, College of Medicine (IRB Log Number: E-22-7446). The purpose of the study, the length of time expected for its completion, and the contact number of the principal investigator were added to the beginning of the survey. A consent statement was added, and the participants provided their consent by choosing to complete the survey. The privacy of the participants and their information was maintained, and there was no disclosure of their names or any information that could identify them. the study was performed in accordance with the guidelines of the Declaration of Helsinki.
Procedure
The Google Forms platform was used to administer the questionnaires, which could be accessed from any electronic device with an Internet connection. In prevalence studies, self-completed online questionnaires have been validated as an effective way to collect data.
The survey was initially tested by 10 experts for content, clarity, and understanding. All their comments were addressed before the distribution of the survey. The usability and technical functionality of the questionnaire was verified by 10 students before it was distributed.
The link to the questionnaire was emailed to the architecture students through King Saud University’s Questionnaire Center, and a reminder email was sent after three weeks. Moreover, the link was additionally sent through social media, using the Twitter account of the architecture students’ club and the students’ group on WhatsApp.
The questionnaires started with general information about the study, the purpose of the research, and the approximate time to complete it. If the students chose to participate, they were informed to provide their consent in order to access the questionnaire. Otherwise, a thank-you note appeared, and the questionnaire was terminated.
The students provided the last four digits of their university identification numbers before they began answering the questions. They also answered general health questions to reveal any exclusion criteria. Some negative responses from specific questionnaires would advance the survey to subsequent sections to speed up its completion. A response was required before moving to the next section. Unless the questionnaire was completed in full, the answers would not be sent. Upon completion of the survey, a screen displayed a message thanking the respondents.
The BMI was calculated based on height and weight, using the formula:
Statistical analysis
Using an Excel spreadsheet, the online questionnaire data were automatically transferred and then imported into a statistical analysis program. IBM SPSS Statistics for Windows version 28 (IBM Corp., Armonk, NY, USA) was used for the analysis. The normality of the data was verified through the Shapiro-Wilk test.
Descriptive statistics in terms of median and first and third quartiles were used to summarize the age, height, weight, and body mass index (BMI) values of the sample. Frequencies and percentages were used for the participant characteristics (academic level and BMI classification) and the data obtained from the NMQ-E questionnaire (pain in the last 12 months, prevention from daily activity, visiting a physician, and pain in the preceding week, regarding all nine body regions), which were measured as categorical variables.
For comparisons based on gender, a Mann-Whitney U test was used to examine age, weight, height, and BMI. Eta (η) was used to assess the correlation between pain present in the preceding seven days and height, weight, and BMI. Pearson’s chi-square test (X2) was used to determine the associations between gender and the data obtained from the NMQ-E. If associations were presented, prevalence odds ratios (OR) were calculated with a 95% confidence interval (CI). The level of significance was set at α= .05 (95% confidence) for all tests of significance.
Results
Participant characteristics
Out of the 484 students enrolled in the architecture and building sciences program of the architecture and planning college, 135 responded to the survey (response rate: 27.9%). Twelve were excluded because they did not agree to participate. A total of 123 students from different academic levels were included in the analysis with ages in the range of 19–25 years. The participant characteristics and the differences between genders are presented in Table 1.
Demographic and academic level data by gender (n = 123)
Demographic and academic level data by gender (n = 123)
*Significant at α= .05. BMI = body mass index. Data presented as median and first and third quartiles except for BMI classification and academic level presented as frequency and percentage, n (%). Gender comparison using the Mann-Whitney U test (except BMI classification and academic level, which used Pearson chi-square test).
There were 116 participants who reported pain in at least one body region (94.3%) within the previous year. Within the last seven days, 107 (87%) reported pain in at least one body region. The body region with the highest percentage of individuals reporting MSP was the neck, followed by the lower back for both pain reported in last 12 months and the last 7 days. A varying number of students (16.3% to 48.8%) reported not being able to conduct everyday activities as a result of pain in different body regions, especially for lower back pain. Moreover, 10.6% to 22% of them reported visiting a physician because of pain (see Fig. 1).
Prevalence of musculoskeletal pain among 123 architecture students.
There were no statistically significant correlations between MSP at different body regions and age, weight, height, or BMI (see Table 2).
Correlations between the demographic variables and MSP in the last seven days (n = 123) using the eta test
Correlations between the demographic variables and MSP in the last seven days (n = 123) using the eta test
*Significant correlation at the.01 level (2-tailed).
Gender was significantly associated with elbow pain reported during the last 12 months (OR = 0.44; 95% CI 0.19, 0.99) and the past 7 days (OR = 0.38; 95% CI 0.14, 1.02) with a higher prevalence among the male participants. On the other hand, the prevalence of wrist/hand pain during the last 12 months (OR = 1.91, 95% CI 0.91, 3.99) was higher among female. Gender did not have a statistically significant association in any of the other comparisons (see Table 3).
Associations between gender and musculoskeletal pain as measured by the NMQ-E (n = 123)
Associations between gender and musculoskeletal pain as measured by the NMQ-E (n = 123)
*Significance at α= .05. X2 = Pearson chi-square, df = degrees of freedom. Prevalence is presented as frequency and percentage of ‘yes’ answers.
The data from this study demonstrate the prevalence of MSP among architecture students and differentiate the prevalence between different genders. Approximately 94.3% and 87.0% of architecture students had reported experiencing musculoskeletal pain within the past 12 months and 7 days, respectively. This pain prevented 16.3% to 48.8% of the students from conducting daily activities, and 10.6% to 22% visited a physician. There was no significant correlation of MSP with age, weight, height, or BMI. There were no significant associations between gender and MSP, except for elbow pain during the last 12 months and the last 7 days and wrist/hand pain during the previous 12 months.
Musculoskeletal pain was shown to be a high prevalence problem for architecture students. The results of this study include higher levels of reported MSP than previous studies that reported MSP within 12 months using the same scale. The prevalence of MSP among Nigerian architecture students was reported to be 78% [10]. In a study in Pakistan, 76.7% of female architecture students reported MSP [19]. Regarding the locations of the MSP, in our study, the neck and lower back were the most prevalent areas, similar to what was found with Pakistani students (24.7% and 18%, respectively) [19]. With Nigerian architecture students, pain in the upper back and elbow was the most prevalent (52.6% and 56.8%, respectively) [10]. The high prevalence of MSP in the current study could be attributed to differences in the academic requirements in the specific curriculum and the lack of similar courses related to work-related pain and dysfunction in the prior study. Moreover, poor awareness and knowledge of ergonomics and awkward postures, prolonged standing, and extended sitting while performing academic assignments and projects could result in more MSP.
Interestingly, Desai and Kapdule revealed that the prevalence of MSP among architects working for at least two years was 80% and that the neck and lower back were the most commonly affected areas [9]. The similarity of results with this study suggests that the MSP being experienced by the students could continue well beyond graduation.
Similar to previous studies conducted among graduate students, regardless of region, MSP did not significantly correlate with BMI [20, 21].
Regarding the association of MSP in different body regions with gender, our results were similar to those of the Nigerian study (except for pain reported in the elbow and wrist/hand in the past 12 months and elbow pain reported in the past 7 days) [10]. However, it is important to mention that for Nigerian students, the MSP association with gender was reported for students in two different major fields of study and not for just architecture students [10].
There was a significant association between gender and the existence of elbow pain, with a higher prevalence among the male participants. Similarly, Walker-Bone et al. reported elbow pain in 12% of males and 10% of females based on an occupational exposure study [22]. Moreover, the current study found that more female students reported wrist/hand pain during the past 12 months than males. This finding is consistent with the findings of a systematic review related to wrist pain that showed the prevalence of wrist pain was higher in females (14.7%) than males (5.6%).
Limitations
A limitation of this study was that it did not examine other risk factors that could affect the prevalence of MSP, such as physical activity level, the level of ergonomic awareness, or the use of suitable equipment during study.
Recommendations
In future studies, the risk factors that could lead to MSP and ergonomic awareness should be examined, especially since this problem seems to persist beyond schooling and continues in their future work environments.
Conclusions
Overall, architecture students had a high prevalence of MSP, mainly in the neck and lower back areas. The presence of MSP in most body regions was not associated with gender. To eliminate the short- and long-term effects of MSP, it is important to plan and implement preventive strategies earlier, as undergraduates are clearly at risk.
Ethical approval
Ethical approval was obtained from the Institutional Review Board of King Saud University, College of Medicine (IRB Log Number: E-22-7446).
Informed consent
Informed consent was obtained from all subjects involved in the study.
Conflicts of interest
The author declares no conflicts of interest.
Footnotes
Acknowledgments
The author thanks Lama Aloreidi, Razan Alasiri, Shuaa Aleiaidi, and Samah Almutairi, students in the physical therapy program at KSU, who helped with data collection.
Funding
The author reports no funding.
Author contributions
The author confirms sole responsibility for the study conception and design, data collection, analysis and interpretation of results, and manuscript preparation.
Data availability statement
The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.